Resection margin status and HPV DNA test as predictor of residual lesion after cervical conization in the management of CIN 3 / 부인종양

OBJECTIVE: To identify resection margin status and HPV DNA test as predictive factors for residual lesion in the management of CIN3 with cervical conization. METHODS: A retrospective study was conducted on 96 patients with CIN3 who had been performed cervical conization (LEEP or CKC) between January 1999 and December 2003 at Soonchunhyang university Chunan hospital. Secondary conization or hysterectomy were performed in case of positive margin on cone specimen or negative margin with other hysterectomy indication. Resection margin status and pre conization HPV DNA test were compared with residual lesion on subsequent cone or hysterectomy specimen. RESULTS: Among 96 cases, 24 cases (15.6%) showed positive resection margin on cone specimen. Of 24 cases with positive resection margin, 2 cases were followed up without treatment, 2 cases were treated with secondary conization and 20 cases were treated with hysterectomy. Of 72 cases with negative resection margin, hysterectomy was performed due to other indication in 16 cases. Persistence of residual lesion in the secondary conization and hysterectomy specimens was significantly correlated with high risk HPV infection and positive resection margin status (p<0.05). CONCLUSION: Conization is good treatment modality of the management of CIN3. HPV DNA test and resection margin status are good predictor of residual lesion after cervical conization for the management of CIN 3. Therefore, when HPV positive and resection margin positive, secondary treatment is mandatory.

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

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.