Management of Patients with CIN III and Positive Margins After Cervical Conization / 대한산부인과학회잡지

ABSTRACT

OBJECTIVE: To evaluate conservative management of patients with cervical intraepithelial lesion, grade III (CIN III) and positive resection margins after cervical conization. METHODS: We reviewed records of 64 patients undergoing cervical conization revealing CIN III with positive resection margins between January 1997 and December 1999. Thirty-three (51.5%) patients underwent conization only and thirty-one (48.5%) underwent conization and subsequent hysterectomy. These patients were followed up with a Pap smear every 3-6 months and then persistence and recurrence were determined in each group. The sites of incomplete excision and HPV infection at cone and residual lesion at hysterectomy specimen were evaluated. RESULTS: Thirty-one of 33 patients receiving conservative management and all 31 patients receiving subsequent hysterectomy had negative Pap smear (P=0.262). In the group of the conservative management, one case of 11 patients with extension to the endocervical margin had positive Pap smear (P=0.577). One of 17 cases with HPV infection and one of 10 cases with negative HPV testing had positive cytology (P=0.630). In the group of subsequent hysterectomy, nine cases (42.86%) of 21 patients with extension to endocervical margin and two (22.22%) of 9 patients with extension to exocervical margin had residual lesion in hysterectomy specimen (P=0.258). Only one (8.33%) of 12 cases with positive HPV and five (50%) of 10 patients with negative HPV had residual lesion (P=0.043). CONCLUSION: Patients with CIN III and positive resection margins after cervical conization can be followed appropriately with serial cytology. Endocervical margin involvement and HPV infection were not statistically significant predictors of residual lesion, persistence and recurrence in our patients.