Prediction of Residual Lesion based on Histopathology and Margin Status of Conization Specimens Related to Post-cone Hysterectomy

Yoon, Young Min; Lee, Joo Yeul; Jun, Hyun Ah; Kim, Hong Bae; Lee, Keun Young; Kang, Sung Won

Abstract

OBJECTIVE
The objective of this study is to evaluate predictive factors for residual lesion after conization in patients with cervical neoplasia.
METHODS
we performed retrospective study (between January 1996 and June 2002) and reviewed 146 patients who had undergone cervical conization followed by subsequent hysterectomy. The age and the parity of patients, the histopathology and the status of resection margins of cone specimens were analysed as predictive values of residual lesions.
RESULTS
The prevalence rate of positive cone margins were 0%, 15%, 43.4%, and 85.7% respectively in patients with low-grade squamous intraepithelial lesion (LSIL) (n=3), high-grade squamous intraepithelial lesion (HSIL) (n=60), Cervical cancer stage I a1 (CC-I a1) (n=76) and Cervical cancer stage I a2 (CC- I a2) (n=7). The prevalence rates of positive residual lesions in post-cone hysterectomy specimens were 0%, 23.3%, 35.5%, and 100% respectively in those with LSIL, HSIL, CC- I a1, and CC- I a2. Residual lesions were significantly more frequently found in patients with positive cone margin (56.3%) than in those with negative margin (21.4%) (P value=0.000026). Positive predictive values of margin status for the presence of residual lesions were 0% (LSIL), 22.2% (HSIL), 57.6% (CC- I a1) and 100% (CC- I a2). Negative predictive values of margin status for the absence of residual lesions were 100% (LSIL), 76.5% (HSIL), 81.4% (CC- I a1) and 0% (CC- I a2). Only 8.3% (4/48) of patients with positive cone margin had more advanced residual lesions. 9.2% (9/98) of patients with negative margins had invasive residual lesion.
CONCLUSION
The prevalence rate of positive cone margin and residual lesion increased with high severity of cervical neoplasia. Patients with positive cone margin had significantly higher chances of having residual lesion than those with negative margin. Free cone margin does not ensure the absence of residual lesion in the remaining cervix. Positive cone margin does not invariably indicate the presence and persistence of more severe residual lesion. Subsequent hysterectomy may be reserved for the patients with invasive cone pathology, concomitant morbid uterine condition, or not reliable for continuous follow-up.