[Study on high risk factors associated with positive margin of cervix conization in patient with cervical intraepithelial neoplasia].

OBJECTIVE: To assess the high risk factors associated with the positive margin of conization in patients with cervical intraepithelial neoplasia (CIN). METHODS: From January 2000 to February 2008, 1699 consecutive patients with CIN undergoing conization was reviewed retrospectively in order to analyze the relationship between the positive margin of conization with clinical prognostic factors, such as patients age, disease grade, size of lesion, the procedure of excision and menopause. chi2 tests was used to compare the different frequencies of factors in groups of positive and negative margin conization, then seven factors with positive margin were processed into unconditional logistic regression analysis. RESULTS: The rate of the positive margin in 1699 patients was 14.01% (238/1699). The mean age of patients with positive margins was (39+/-9) years old, while patients with negative margins was (39+/-8) years old, which didn't reach statistical difference (P>0.05). The rate of the positive margin was 8.63% in cold knife cone (CKC) and 18.66% in loop electrosurgical excision procedure (LEEP), which showed significant difference (P<0.01). Among 1699 patients, 90 patients were with CINI, 339 patients were with CIN II, 1113 patients were with CIN III [including 972 with severe dysplasia and 141 with cancer in situ (CIS)], 87 patients were with cervical cancer stage Ia1, 70 patients were with stage Ia2 or advanced stages. The rate of positive margin was 1.11% (1/90), 3.83% (13/339), 10.70% (104/972), 26.24% (37/141), 35.63% (31/87) and 74.29% (52/70), respectively. There was statistic difference among them, except CINI and CINII. When combined CIN I with CIN II, then compared with CIN III, cervical cancer with Ia1 and Ia2, it also showed statistical difference (P<0.05). The rate of positive margin in postmenopausal women was 21.54% (28/130), which was significantly higher than 13.38% (210/1569) in premenopausal women (P=0.010). The logistic regression analysis showed that the procedure of excision, grade of disease, size of lesion, surface of cervix, and menopause were high risk factors associated with the positive margin, the risk ratio were 5.147, 3.048, 1.271, 1.905 and 1.860, respectively. CONCLUSIONS: High grade, the extent of CIN disease, LEEP and postmenopausal age are high-risk factors associated with positive margin in patients treated by conization. It should be warranted in those patients when designing conization treatment.

Factors associated with positive margins in patients with cervical intraepithelial neoplasia grade 3 and postconization management.

OBJECTIVE: To evaluate the risk factors for positive margins in cervical intraepithelial neoplasia (CIN) grade 3 and the outcomes of postconization management. METHODS: A retrospective review of the records of 1113 women who underwent conization for CIN 3 between 2000 and 2008. RESULTS: Positive margins occurred in the following: 104 (10.7%) women with severe dysplasia versus 37 (26.2%) with carcinoma in situ; 32 (4.8%) treated with cold knife conization versus 109 (24.1%) treated with the loop electrosurgical excision procedure (LEEP); and 124 (11.6%) premenopausal versus 17 (35.4%) postmenopausal women. None of the women with severe dysplasia had invasive disease in the repeat excision specimen, whereas 3 (8.6%) women with carcinoma in situ had residual microinvasive carcinoma. CONCLUSION: LEEP, carcinoma in situ, menopausal status, and larger area of lesion are risk factors for positive margins. For women with CIN 3 and positive margins, follow-up at an interval of 6 months or repeat excision are treatment options. However, when repeat excision is technically impossible, whether simple hysterectomy or radical surgery is a rational treatment option requires further investigation.