Colposcopy Directed Cone Biopsy and Endocervical Curettage as Management of Carcinoma in Situ of the Uterine Cervix

Jung, Yong Wook; Cho, Jung Mi; Kwon, Ja Young; Kim, Sung Hoon; Park, Tchan Kyu

Abstract

OBJECTIVE
The goal of this study was to evaluate the prognostic factors in relation with residual cervical intraepithelial neoplasia (CIN) in hysterectomized specimen of the patients diagnosed as carcinoma in situ of the uterine cervix (CIS) and underwent cone knife biopsies first. Also we investigated if colposcopically directed wide cone knife biopsy with endocervical curettage followed by electrocauterization could substitute for traditional hysterectomy as a conservative management of CIS.
METHODS
Data were collected retrospectively from 169 patients who were diagnosed as CIS after colposcopy directed conization in Yonsei University Hospital from Jan 1997 to Dec 2001. The patients were divided into two groups, those who underwent colposcopically directed cone biopsy only (Group A) and those who received colposcopically directed cone biopsy and extrafascial abdominal hysterectomy (Group B). Pap smear, pelvic examination and punch biopsy of the uterine cervix according to symptoms and physical findings of the patients were performed for follow-up. Patient characteristics, histologic results and follow-up outcomes were compared using student t-test, x2 test, and logistic regression analysis.
RESULTS
Among 169 patients, 82 (study group) received no further treatment while 87 (control group) were hysterectomized. 58 of control group showed residual CIN in colposcopically directed cone biopsy and 12 from these patients, residual CIN were found in hysterectomized specimen. Positive endocervical margin on conization was found as a significant predictor for residual disease after conization. Abnormal Pap smear results were reported in 10 patients of study group only, of whom 2 cases of CIN I, 8 cases cervicitis.
CONCLUSION
The residual CIN in endocervical margin can predict whether hysterectomized specimen might contain residual CIN and no difference in life threatening prognosis existed between the patients received colposcopically directed cone biopsy only and hysteretomy, regardless of the residual CIN in cone biopsy margin. Based on these results, it is reasonable to choose expectant management over hysterectomy for treating CIS patients with marginal involvement.