Prediction of Residual Neoplasia Based on Pathologic Severity and Resection Margin Status of Conization Specimens

Park, Chang Soo; Moon, Jong Taek; Whang, Jong Dae; Joo, In Sook; Song, Sang Yong; Bae, Duk Soo; Lee, Je Ho

Abstract

OBJECTIVE: To evaluate the status of cone margins and severity of cervical neoplasia as predictors of residual lesions in the remaining cervices, and provide guideline for further treatment or close follow-up. METHOD: We performed a 3-year retrospective study and reviewed 95 patients who had undergone cervical conization followed by subsequent hysterectomy. RESULT: The prevalence rates of positive cone margins were 33, 50, 44, 71 and 88% respectively in patients with cervical intraepithelial neoplasia(CIN)II, CIN III, cervical cancer stage Ia1, Ia2 and Ib1. The prevalence rates of positive residual lesions in postcone hy-sterectomy specimens were 0, 31, 19, 29 and 59% respectively in patient with CIN II, CIN III, cervical cancer Ia1, Ia2 and Ib1. Residual lesions were significantly more frequently found in patients with positive cone margins(51%) than in those with negative margins(4.8%). Positive predictive values of margin status for the presence of residual lesions were 0, 56, 36, 40 and 67% respectively. Negative predictive values of margin status for the absence of residual lesions were 100, 94, 94, 100 and 100% respectively.
CONCLUSIONS
(1) The prevalence of positive cone margin and residual lesion increased with more severe cervical neoplasia. (2) Positive cone margins had significantly higher risks of residual lesion than negative cone margins. (3) Positive cone margin does not invariably indicate the presence of residual lesion. (4) Negative cone margin does not ensure the absence of residual lesion. Subsequent hysterectomy may be reserved for the patient with CIN III or cervix cancer having positive cone margin or invasive lesion, or the patient who is not reliable for continuous follow-up.