The value of circulating miR-143 level in predicting early response to concurrent chemoradiotherapy in cervical cancer patients / 中华放射肿瘤学杂志

Objective:To investigate the value of serum miR-143 level combined with MRI in predicting the early response to concurrent chemoradiotherapy (CCRT) in cervical cancer.Methods:A total of 85 patients with pathologically confirmed cervical cancer underwent conventional MRI, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), and dynamic contrast-enhanced MRI (DCE-MRI) before CCRT. The biopsy tissues and serum samples were collected. The differential expression of miRNA in the biopsy tissues was determined by microarray chip. The expression level of miR-143 in the serum samples was analyzed by qRT-PCR. All patients were divided into the non-residual and residual tumor groups according to post-treatment MRI. Pre-treatment clinical factors, MRI parameters and miR-143 between two groups were statistically analyzed by the univariate and multivariate analyses. The optimal thresholds and predictive performance for post-treatment incidence of residual tumors were estimated by drawing the ROC curve.Results:At one month after CCRT, there were 52 patients in the non-residual tumor group and 33 patients in the residual tumor group. In the residual tumor group, pre-treatment FIGO staging, apparent diffusion coefficient (ADC), D and V e were significantly higher (all P<0.05), whereas K trans value was significantly lower ( P<0.001) when compared to those in the non-residual tumor group. The miRNA array analysis showed that there were 16 miRNAs with differential expression levels between two groups (all P<0.05). Among them, the increase of miR-143 was the most significant in the residual tumor group. Compared with the residual tumor group, the expression level of serum miR-143 was significantly down-regulated in the non-residual tumor group ( P=0.002). Compared with the SiHa cells, the expression level of miR-143 in the SiHa-R cells was significantly up-regulated ( P<0.05). Multivariate analysis showed that only miR-143, D, K trans and V e were the independent prognostic factors. The combination of multi-parametric MRI and miR-143 exhibited the highest predictive performance (AUC=0.975), with a sensitivity of 84.8% and a specificity of 96.2%. Conclusion:The combination of multi-parametric MRI with miR-143 further improves the predictive performance for residual tumors after CCRT, which contributes to the personalized treatment of cervical cancer.

Diffusion-weighted MRI in residual foci evaluation of uterine cervical cancer after chemoradiation therapy / 实用放射学杂志

Objective To evaluate the usefulness of diffusion-weighted MR combined with routine T2 WI in finding the possible residual foci in uterine cervical cancers after radical chemo-radiation therapy.Methods This was a retrospective study including 25 consecutive cervical cancer patients who received hysterectomy after radical chemo-radiation therapy.All of them underwent MR examinations post-chemoradiation and just before operation.Images of T2 WI alone and those of T2 WI combining DWI were evaluated respectively by 2 senior radiologists,in order to decide whether there were residual tumors.ADC values were also measured.Taking the post-operation pathological results as the gold standard,the accuracies,sensitivities and specificities of T2 WI alone,T2 WI combining DWI,and ADC values were all calculated.Results In those 25 patients,9 were found with foci of residual cancer in operative pathology,while no cancer cells were found in the other 1 6 patients.The accuracy,sensitivity and specificity in finding the positive residual cancer using T2 WI alone were 56.0%,77.8% and 43.8%,comparing with 72.0%,66.7% and 75.0% in T2 WI combining DWI.The accuracy and specificity increased with statistical significance after combining DWI (P =0.01 6 for accuracy,P =0.031 for specificity),while the sensitivity decreased but did not reach statistically significant level (P =0.099).No difference in ADC values was found.Conclusion DWI can be used as a supplementary sequence in finding the existence of residual tumors of cervical cancer after radical chemo-radiation therapy.Routine T2 WI combing DWI increased the specificity and accuracy,but still facing the risk of decreasing sensitivity.

Is the Complete Resection of Craniopharyngiomas in Adults Feasible Considering Both the Oncologic and Functional Outcomes?

OBJECTIVE: To assess the impact of the complete resection of craniopharyngioma (CP) in adults on oncologic and functional outcomes. METHODS: We retrospectively analyzed 82 patients with CP who were surgically treated by the same neurosurgeon at our institution between January 1994 and December 2012. RESULTS: Gross total resection (GTR) was achieved in 71 patients (86.6%), near total resection (NTR) in 7 patients (8.5%), and subtotal resection (STR) in 3 patients (3.7%). The disease-specific overall survival rate was 100% with the exclusion of 2 surgery-related mortalities. The overall recurrence rate was 12.2% (10 of 82 patients), however the recurrence rate according to extent of resection (EOR) was 9.9% (7 of 71 patients) after GTR, 14.3% (1 of 7 patients) after NTR, and 66.7% (2 of 3 patients) after STR. The overall recurrence-free survival (RFS) rates at 5 and 10 years were 87.0% and 76.8%, respectively. Postoperatively, most patients (86.3%) needed hormone replacement for at least 1 hypothalamic-pituitary axis. Vision improved in 56.4% of the patients with preoperative abnormal vision, but deteriorated in 27.4% of patients. Hypothalamic dysfunction developed in 32.9% of patients. There were no significant differences in the risks of pituitary dysfunction, visual deterioration, or hypothalamic dysfunction between the groups with complete vs. incomplete removal. The overall rate of postoperative complications was 22.0%, which did not differ between groups (p=0.053). CONCLUSION: The complete removal of a CP at first surgery can provide a chance for a cure with acceptable morbidity and mortality risks.

Tuftsin-derivated TP affects MIP-1αexpression of tumor associated macrophages / 中国药理学通报

Aim To investigate the effect of TP on the expression of macrophages inflammatory protein ( MIP-1α) . Methods Total RNA of mouse Ana-1 cells and tumor associated macrophages were extracted, and MIP-1α mRNA was detected by RT-PCR. Mouse S180-xenografts were established by injecting S180 cells subcutaneously into the double abdominal flanks of the mice. The postoperative residual tumor models were generated in the right abdominal tumors when tumors grew into 250 mm3 . Animals were treated with TP or CTX, and tumor tissues were separated and MIP-1α was detected by immunohistochemistry. Results There was no significant difference of the expression of MIP-1α between Ana-1 cells and TAMs. TP couldn’ t affect MIP-1αexpression in Ana-1 cells while it signifi-cantly decrease MIP-1α expression in TAMs in a dose-dependent manner. TP significantly decreased MIP-1αexpression of tumor tissue compared with control group. Conclusions MIP-1α will be a new target of TP anti-cancer. Simple cell line tests in vitro couldn’ t reveal the real state in vivo.

Resección laparoscópica de linfangioma cavernoso retroperitoneal residual / Laparoscopic resection of a residual retroperitoneal cavernous lymphangioma

Objetivo: Presentar el caso de una paciente con linfangioma cavernoso diagnosticado incidentalmente y tratado quirúrgicamente, primero por laparotomía y después, para su resolución final, mediante laparoscopia. Se discuten las ventajas de la cirugía miniinvasiva como método adyuvante en la resección del linfangioma residual después de una laparotomía extensa. Sede: Hospital de tercer nivel. Diseño: Presentación del caso y revisión de la literatura. Descripción del caso: Mujer de 43 años, en la cual se documentó masa quística aparentemente dependiente del ovario derecho, con marcadores tumorales para cáncer ovárico normales. Se programó para salpingoclasia y resección de quiste ovárico, por incisión Pfannenstiel, encontrando un quiste gigante de origen retroperitoneal, que se extendía desde el hueco pélvico hasta el abdomen superior. Fue extirpado casi en su totalidad, debido a la extensión de la tumoración, excepto en la porción pancreatoduodenal y retrohepática, ya que al intentar abordar esta zona, inició con sangrado transoperatorio y se desconocían las relaciones del tumor con estos órganos. Se difirió la resección de esta porción residual para complementar su estudio por imágenes e histopatología y llevarlo a cabo en un segundo tiempo quirúrgico. La tomografía postoperatoria no mostró dependencia pancreatoduodenal, biliar o vascular. Al mes, se programó para la resección laparoscópica del tumor residual. El reporte histopatológico fue linfangioma cavernoso en ambos casos. Conclusiones: El tratamiento para los linfangiomas retroperitoneales es la resección completa. La cirugía miniinvasiva es una alternativa útil, ventajosa y mejor aceptada por los pacientes en algunas reoperaciones planeadas, donde inicialmente se realizó cirugía abierta.

Objective: To present the case of a woman with cavernous lymphangioma incidentally diagnosed and surgically treated, first through laparotomy and later, for its final resolution, through laparoscopy. We discuss the advantages of mini-invasive surgery as an adjuvant method for the resection of a residual lymphangioma after extensive laparotomy. Setting: Third level health care hospital. Design: Case presentation and review of the literature. Case description: A 43-year-old woman, in whom a cystic mass, apparently depending on the right ovary was documented; tumor markers for ovarian cancer were normal. She was programmed to undergo salpingoplasty and resection of the ovarian cyst, through Pfannenstiel incision. During surgery a giant cyst of retroperitoneal origin was found, which extended from the pelvic hole to the upper abdomen. It was resected almost totally due to the extension of the tumor, except for the pancreatoduodenal and retrohepatic region, because, when attempting to approach this area, transoperative bleeding started and we did not know the relations of the tumor with these organs. The resection of this residual portion was deferred to be able to complement the diagnosis with imaging and histopathology studies and perform the resection at a second surgical time. Postoperative tomography revealed no pancreatoduodenal, biliary, or vascular dependence. After 1 month, the patient was programmed for laparoscopic resection of the residual tumor. The histopathological report corresponded to cavernous lymphangioma in both situations. Conclusions: Treatment of retroperitoneal lymphangiomas consists of complete resection. Mini-invasive surgery is a useful, valuable option and a better accepted alternative by patients in some planned re-operations where initially open surgery had been performed.

Risk factors for incomplete resection in ESD for precancerous lesions and early cancer in upper digestive tract / 中华消化内镜杂志

Objective To explore the reasons for lateral and basal incomplete resection of precancerous lesions or cancer from upper digestive tract by endoscopic submucosal dissection (ESD).Methods Data of 295 patients undergoing ESD for upper gastrointestinal precancerous lesions or cancer from November 2006 to October 2011 were collected,and reasons of basal or lateral incomplete resectin confirmed by postESD pathology were analyzed.Results The total incomplete resection rate after ESD was 3.05％ ( 9/295 ).Among 95 cases of esophageal ESD,there was 1 case of lateral margin incomplete resection because of the retraction of normal tissue after dissection.Among 200 cases of gastric ESD,there were 5 cases of lateral margin incomplete resection,in which 2 cases were signet ring carcinoma with submucosal infiltration and spreading,2 were due to retraction of normal tissue after dissection,and 1 was due to inaccurate judgment on cancer demarcation.There were 3 cases of basal incomplete resectin in gastric ESD,which was caused by incorrecte invasion depth estimation before ESD.Conclusion The rate of basal or lateral incomplete resection in upper gastrointestinal ESD was low,which is related to pathological type,ESD procedure and estimation of invasion depth before ESD.

Effect of tumor angiogenesis on rapid progression of residual tumor of liver cancer after radiofrequency ablation / 中华普通外科杂志

Objective To explore experimently the effect of tumor angiogenesis on rapid progression of residual tumor of liver cancer after radiofrequency ablation ( RFA). Methods A rabbit VX2 hepatoma model was established. Inoculated tumors were treated by using RFA at 55 ℃ , 70 ℃ and 85 ℃ respectively to establish the residual VX2 hepatoma model. Rabbits implanted with VX2 hepatoma but receiving no RFA treatment served as controls. The expression of vascular endothelial growth factor (VEGF)was determined in tumors to assess the relationship between VEGF and the focal tumor volume and distant metastasis. The expression of VEGF and microvessel density ( MVD) in tumor tissues was assessed by immunohistochemistry. The protein expression of VEGF was assessed by Western blot. The expression of VEGF mRNA was detected by RT-PCR. Results There were significant differences of the local tumor volume between the control group (9.91 ±0.98) cm3 and the other groups (respectively t = -17.43,-10.11, -8.79,all P<0. 05). Compared with the 70 ℃ group (17. 08 ±2. 28 ) cm3 and the 85 ℃ group (15.95 ±4.95) cm3, the focal tumor volume of 55 ℃ group was the largest (21.26 ±2.32) cm3,( respectively t = 4. 69,6. 78, all P<0. 05). Much more metastatic lesions of lung were observed in the RFA treated groups in comparison to the control group. Moreover, the lung metastasis in 55 ℃ group was the most serious among the three RFA treated groups (respectively t = -21.65, -30. 15, all P<0. 05 ).Immunohistochemical staining indicated that the expression of VEGF and MVD in the RFA treated groups was much higher than those in control group ( MVD respectively t = -13.01, -5. 46, -5. 63, all P<0. 05), ( VEGF respectively t = 8. 00,4. 92,4. 21, all P<0. 05 ). Furthermore, the expression of both VEGF protein and VEGF mRNA in 55 ℃ group was the highest among the three RFA treated groups.Conclusions The over-expression of VEGF accelerating the tumor angiogenesis may be one of the mechanisms inducing rapid progression of residual liver tumor after RFA.

Analysis of residual tumor based on pathologic severity and site of positive margin after cold-knife conization of the uterine cervix / 대한산부인과학회지

OBJECTIVE: To evaluate correlation of sites of positive margin and residual tumor and to establish management after conization. METHODS: Of 599 cold-knife conizations [15 (2.6%) with cervical intraepithelial neoplasia (CIN) I, 37 (6.1%) with CIN II, 450 (75.1%) with CIN III, 97 (16.2%) with microinvasion] performed at our institution from January, 1993 to June, 2006, 144 patients (24.0%) had positive margins and 113 patients were included in the retrospective study excluding 31 cases that were not followed more than 12 months. Correlation of conization pathology and residual tumor according to sites of positive margin were evaluated. RESULTS: The prevalence rates of positive margins were 6.7% (1/15) in CIN I, 21.6% (8/37) in CIN II, 21.1% (95/450) in CIN III, and 41.2% (40/97) in microinvasion. The prevalence rate of positive margin increased with severity of conization pathology (P=0.0001). Of 113 patients followed more than 12 months, 27.4% (31/113) had residual tumor [0.0% (0/1) in CIN I, 12.5% (1/8) in CIN II, 18.9% (14/74) in CIN III, and 53.3% (16/30) in microinvasion]. The prevalence rate of residual tumor increased with severity of conization pathology (P=0.0028). Residual tumor was more common in patients in whom both endocervical and exocervical margins or in whom only the endocervical margin were involved than in those in whom only exocervical margin was involved [87.5% (7/8) or 35.3% (24/68) versus 0% (0/37), respectively]. CONCLUSIONS: Expectant management is reasonable for patients with positive margin after conization. However, careful follow-up of these patients is essential, particularly in endocervical involvement.

Evaluación del corregistro de imágenes de resonancia magnética y tomografía por emisión de positrones con 2-desoxy-2-flúor-d-glucosa marcada con flúor-18 en pacientes con patología tumoral cerebral / Validation of MRI and 18F-FDG-PET coregistration in patients with primary brain tumors

Objetivo: Determinar la efectividad del co-registro de imágenes PET/RM (tomografía de emisión de positrones y resonancia magnética) en el diagnóstico de recidiva tumoral vs.. radionecrosis en pacientes con patología tumoral cerebral primaria previamente tratados. Material y métodos: El diagnóstico de tumor cerebral se determinó por RM e histopatología. Después de 3 a 5 meses postratamiento se realizó RM y PET como parte del seguimiento. El análisis de dichas imágenes se hizo de manera visual y semicuantitativa mediante la obtención de un índice de captación de 18F-FDG de tejido tumoral/ tejido cerebral sano. Resultados: Se estudiaron 57 pacientes; un total de 37 gliomas astrocíticos, 9 gliomas mixtos, 5 tumores embrionarios, 1 tumor meníngeo y 1 tumor oligodendroglial . Todas las imágenes de RM presentaban áreas de reforzamiento, dejando sospecha entre radionecrosis o viabilidad tumoral; con el co-registro PET/RM se diagnosticaron 21 estudios negativos (30 %) y 36 positivos (70 %). El índice tejido tumoral/tejido cerebral sano se correlacionó adecuadamente con los resultados visuales obtenidos. Conclusión: La RM sobreestima el área tumoral a valorar. La presencia de la actividad metabólica analizada mediante PET sobre las áreas de reforzamiento por RM permite determinar la presencia de viabilidad tumoral. Esto aumenta la certeza diagnóstica de ambas técnicas de imagen.

OBJECTIVE: To evaluate the role of PET and MRI fused image study inpatients with primary brain tumors previously treated, to determine the presence of radionecrosis vs residual tumor viability. METHODS: Primary brain tumors were diagnosed by biopse and MR. 18FDG-PET scan and T1 enhanced MRI follow-up studies were performed between 3 and 5 months after treatment. The 18F-FDG uptake was semiquantitavively calculated by a region-of-interest based Tumor hotspot/normal brain tissue index. RESULTS: Fifty-seven patients were studied, 37 had high grade gliomas; 9 had oligoastrocytomas; 5 had Embrionary tumors; I had a meningyoma and I had an oliodendroglial tumor. All MR studies showed tumor enhancement, without determine wether if it was radionecrosis or tumor viability. PET/MR fused study diagnosed 21 negative studies (30%) and 36 positive results (70%). Tumor hotspot/normal brain tissue index correlated well with the visual analysis registered. CONCLUSIONS: Visual analysis in the contrast enhanced MR overestimates the tumoral area, without defining a possible diagnosis between tumor viability and radionecrosis. Metabolic activity in the 18F-FDG PET study in the enhanced area, determines the presence of residual tumor viability. Therefore, coregistration can be used to obtain a more specific diagnosis optimizing the cinical use.

The analysis of prognostic factors in patients with epithelial ovarian cancer / 대한산부인과학회지

OBJECTIVE: To determine pathologic variables associated with overall survival and disease free survival of patients with epithelial ovarian cancer. METHODS: Diesease free survival and overall survival of 80 ovarian cancer patients treated with primary surgery between January 1997 and December 2003 at our center were compared about various histopathologic variables. Survival analyses were performed by the Kaplan-Meier curves and the log-rank test. Independent prognostic factors were determined by Cox's proportional hazards model. RESULTS: With regard to disease free survival, univariate analysis revealed no significant differences in subgroups according to age category, histologic type and grade. However, significant differences in disease free survival were found in stage category and residual tumor volume. Among these significant subgroups, the Cox-proportional hazards model showed that residual tumor volume was the only independent prognostic factor. There were significant differences in the overall survival of patients in subgroups according to stage categoty and residual tumor volume. Multivariate analysis revealed that residual tumor volume was the only independent significant adverse prognostic factor. CONCLUSION: Our results showed that only residual tumor volume was the independent prognostic factor of disease free survival and overall survival in epithelial ovarian cancer patients.

Avaliação do tecido glandular e neoplasia residual no retalho cutâneo após mastectomia com preservação de pele por câncer de mama / Evaluation of glandular tissue and residual tumor in the skin flap after slin-parking mastectomies due breast cancer

O objetivo do trabalho foi avaliar a prevalência de tecido glandular e neoplasia residual no retalho cutâneo de pacientes submetidas à mastectomia com preservação de pele (MPP). Quarenta e duas mulheres portadoras de carcinoma de mama, estadio 0 a III, foram submetidas à MPP entre junho de 2003 e janeiro de 2004. Antes da cirurgia, foram desenhadas duas linhas na pele da mama, representando as incisões da MPP e da mastectomia convencional. Após a cirurgia, o retalho cutâneo que permaneceria após a MPP foi retirado. Neste, foram avaliadas a presença de tecido glandular mamário, através da identificação de unidades ducto tubulares alveolares (UDTL), assim como, a presença de neoplasia residual, por microscopia óptica. Estes dados foram correlacionados com outros parâmetros clínicos e patológicos, através de teste exato de Fisher e curva ROC. Em 25/42 (59,5%) dos casos havia UDTL remanescente, associada significativamente com espessura do retalho cutâneo > 5 mm. Em 4/42 das pacientes havia neoplasia residual na pele, associada à espessura > 5mm e presença de UDTL. A curva ROC mostrou que conforme a espessura do retalho cutâneo diminui, também diminui a prevalência de UDTL. Foi concluído que alta prevalência de UDTL e de neoplasia residual estiveram associadas a espessuras de retalhos cutâneos > que 5 mm.

The objective of the study was to evaluate the prevalence of glandular tissue and residual tumor in the skin flap after skin-sparing mastectomies (SSM). Forty-two breast cancer female patients, stage 0 - III, without clinical skin involvement, underwent SSM from June 2003 to January 2004. Before surgery, two lines were drawn on the breast skin, representing SSM and conventional mastectomy incisions. After surgery, the skin flap that would remain after SSM was removed and immediate breast reconstruction was begun. The presence and amount of remaining glandular breast tissues were histologically evaluated in the skin flap, identifying terminal duct-lobular units (TDLU) under an optical microscope, as well as the presence of residual disease. These data were correlated with other clinical and pathological parameters, using the Fisher exact test and ROC curve. The prevalence of residual breast tissue in the sample was 59,5% (25/42) and the presence of TDLU was significantly associated with skin flaps thicker than 5mm. Residual disease was found in 9,5% (4/42) of the women and associated with skin flaps > 5mm thick and presence of TDLU. The ROC curve showed that, as skin flaps reduces in thickness, the presence of TDLU also decreases. It was concluded that a high prevalence of glandular breast tissue and residual disease in the skin flap were associated with skin flaps thickness > 5mm.

The Result of Re-excision Following Unplanned Excision of Soft Tissue Sarcoma of the Extremities / 대한정형외과학회잡지

PURPOSE: This study examined the effect of a microscopic residual tumor on the survival and recurrence rate by analyzing patients who had undergone a re-excision after an unplanned excision of a soft tissue sarcoma. MATERIALS AND METHODS: From December 1985 to June 2002, 68 unplanned excisions of a soft tissue sarcoma at other institutes were referred to our service. All cases had undergone a re-excision and were re-evaluated for residual tumors. The male to female ratio was the same with an average age of 34.7 years. Staging followed the AJCC classification and there were 3 cases of Ia, 2 Ib, 5 IIa, 34 IIb, 24 III. Twenty six cases underwent surgical treatment only and 42 had added adjuvant therapy. The mean follow-up was 58.9 months. RESULTS: At the final follow up, there were 48 CDF, 9 NED, 3 AWD and 8 DOD. The CDF 5/16 year survival rates were 68.1/61.3%. Eight of the 23 residual tumor positive cases and 6 of the 45 residual tumor negative cases had a local recurrence. The tumor size, residual tumor, interval between the excision and reexcision, and stage were significant factors for a local recurrence. Statistical analysis revealed a local recurrence, metastasis and stage to be significant factors for survival. CONCLUSION: Local recurrence was the only controllable factor for survival. The presence of a residual tumor had an impact on the local recurrence. A re-excision after an unplanned excision may reduce the incidence of a local recurrence.

The Impact of Transurethral Resection of Bladder Tumor: Clinicopathologic Analysis of Cystectomy Specimen to Evaluate Residual Tumor / 대한비뇨기과학회지

PURPOSE: We analyzed the impact of transurethral resection of the bladder (TUR-B) in patients with bladder cancer, in whom a subsequent cystectomy was performed. MATERIALS AND METHODS: We reviewed the records of 93 patients, with clinical stage T2 or less transitional cell carcinomas of the bladder that underwent a radical cystectomy at our institute. Before the radical cystectomy, TUR-B was performed for diagnostic and therapeutic purposes in all patients. We used the term "complete TUR" for the following procedures. No residual tumors were found after the TUR endoscopically, also, muscle layer should be present in the TUR specimens and no gross residual tumors were found in the cystectomy specimens by the pathologist. RESULTS: Eleven (26.8%) of the 41 patients with superficial bladder cancer had no evidence of residual tumors. Of the 19 patients with superficial bladder cancer that underwent complete TUR-B, 10 (52.6%) had no residual tumors. For the invasive tumors, 10 (19.2%) of the 52 patients that had a T2 stage disease had no residual tumors, and 10 (29.4%) of the 34 patients with a T2 stage disease, who underwent complete TUR-B, had no residual tumors. In the 38 patients with superficial bladder cancer, 17 (44.7%) changed to a higher stage. Of the 17 patients who underwent complete TUR-B, 3 (17.7%) changed to a higher stage. Among the patients with a T2 stage disease, those with the pT0 stage had a better survival than those with the pT2 stage with residual tumors (p=0.04). CONCLUSIONS: The completeness of TUR-B is important in evaluating residual tumors after a previous TUR-B in those patients with both superficial and invasive bladder cancers.

Diagnostic Accuracy of Cytology, Colposcopically Directed Biopsy and Conization and Predictive Factors for Residual Tumor after Conization in Patients with Cervical Neoplasia / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the diagnostic accuracy of cytology, colposcopically directed biopsy and conization and to analyze predictive factors for residual tumor after conization in patients with cervical neoplasia. METHODS: We reviewed 167 patients who had undergone cytology, colposcopically directed biopsy and conization followed by subsequent hysterectomy depending on their current disease status at the Department of Obstetrics & Gynecology, Catholic University of Korea Medical College, Holy Family Hospital from January, 1993 to August, 1998. The diagnostic accuracy of cytology, colposcopically directed biopsy and conization were investigated. Also, we investigated the significance of the margin status and the presence of HPV which were used to predict residual tumors in hysterectomy specimens after conization. RESULTS: The results of each methods were analyzed with regard to the histopathologic findings of the surgical specimen. The accuracy rates of cytology, and colposcopically directed biopsy were 59.3% (99 of 167) and 71.3% (119 of 167), respectively. After conization, residual tumors were found in 30.1% of subsequent hysterectomized specimens (51 of 167). Underestimation by conization occurred in 2.0% of cases (1 of 51) and overestimation in 7.8% (4 of 51). Residual tumors were significantly more frequent in patients with positive conization margins than in those with negative margins (P<0.001). But the presence of HPV was not significant. CONCLUSION: These results suggest that diagnostic conization seems to be essential procedure in patients showing abnormal results by cytology and colposcopically directed biopsy, especially in those with CIN III or microinvasion, for the further proper management of cervical neoplastic lesion and margin status is useful in predicting residual tumor after conization.