Evaluation of hysterectomies after cervical conization with positive surgical margins: a review of 252 cases

Abstract

Aim: To evaluate final pathological results of hysterectomies which were done after the finding of positive cervical conization margin.

Methods and Material: Thirty-five patients underwent hysterectomy after cervical conization revealing positive surgical margins among 252 patients who had undergone cervical conization between 2005 and 2013 were included in this study.

Results: Mean age of the patients were 38,79 ± 8,82. Hysterectomies were performed in 1,57 ± 1,24 months following conization. Dysplasia was revealed in only 9 hysterectomy specimens (9/35), 6 High grade CIN, 3 Low grade CIN.

Conclusion: A careful follow-up can be a good alternative to post-cone hysterectomy or reconization decision after the finding of positive cervical conization margin.

 

 

Keywords

• Conization; Cervical intra-epithelial neoplasia; Hysterectomy; Positive surgical margin

Servikal konizasyon sonrası cerrahi sınır pozitifliği olan ve histerektomi yapılan 252 olgunun değerlendirilmesi

Öz

Amaç: Konizasyon sonrası cerrahi sınır pozitif gelen ve histerektomi yapılan olguların patoloji sonuçlarının değerlendirilmesi amaçlanmıştır.

Gereç ve Yöntem: 2005-2013 yılları arasında hastanemizde servikal konizasyon yapılan (252) olgulardan cerrahi sınır pozitifliği olan ve histerektomi yapılan 35 olgunun patoloji sonuçları  değerlendirilmiştir.

Bulgular: Hastaların ortalama yaşı 38,79 ± 8,82 yıldır. Konizasyondan ortalama 1,57 ± 1,24 ay sonra histerektomi yapılmıştır. Histerektomi materyallerinin 9’unda displazi (9/35), 6’sında CIN2-3, 3’ünde ise CIN1 saptanmıştır.

Sonuç: Konizasyon sonrası cerrahi sınır pozitifliği olan olgularda, yakın izlem reonizasyon veya histerektomiye alternative olarak uygulanabilir.

Anahtar Kelimeler

• Konizasyon, Servikal intraepitelyal neoplazi, Histerektomi, Pozitif cerrahi sınır

Kaynakça

1. References
2. Ghaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol. 2007;8(11):985-993.
3. Reich O, Pickel H, Lahousen M, Tamussino K, Winter R. Cervical intraepithelial neoplasia III: long-term outcome after cold-knife conization with clear margins. Obstet Gynecol. 2001;97(3):428-430.
4. Felix JC, Muderspach LI, Duggan BD, Roman LD. The significance of positive margins in loop electrosurgical cone biopsies. Obstet Gynecol. 1994;84(6):996-1000.
5. Husseinzadeh N, Shbaro I, Wesseler T. Predictive value of cone margins and post-cone endocervical curettage with residual disease in subsequent hysterectomy. Gynecol Oncol. 1989;33(2):198-200.
6. Reich O, Lahousen M, Pickel H, Tamussino K, Winter R. Cervical intraepithelial neoplasia III: long-term follow-up after cold-knife conization with involved margins. Obstet Gynecol. 2002;99(2):193-196.
7. Moore BC, Higgins RV, Laurent SL, Marroum MC, Bellitt P. Predictive factors from cold knife conization for residual cervical intraepithelial neoplasia in subsequent hysterectomy. Am J Obstet Gynecol. 1995;173(2):361-366; discussion 366-368.
8. Lu CH, Liu FS, Tseng JJ, Ho ES. Predictive factors for residual disease in subsequent hysterectomy following conization for CIN III. Gynecologic oncology. 2000;79(2):284-288.

9. Mohamed-Noor K, Quinn MA, Tan J. Outcomes after cervical cold knife conization with complete and incomplete excision of abnormal epithelium: a review of 699 cases. Gynecologic oncology. 1997;67(1):34-38.
10. Manchanda R, Baldwin P, Crawford R, et al. Effect of margin status on cervical intraepithelial neoplasia recurrence following LLETZ in women over 50 years. BJOG. 2008;115(10):1238-1242.
11. Paterson-Brown S, Chappatte OA, Clark SK, et al. The significance of cone biopsy resection margins. Gynecologic oncology. 1992;46(2):182-185.
12. Shaco-Levy R, Meirovitz M, Eger G, Benharroch D, Dreiher J. Post-conization endocervical curettage for estimating the risk of persistent or recurrent high-grade dysplasia. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2013;121(1):49-52.
13. Kim WY, Chang SJ, Chang KH, Yoo SC, Ryu HS. Conservative management of stage IA1 squamous cell carcinoma of the cervix with positive resection margins after conization. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2010;109(2):110-112.
14. Lapaquette TK, Dinh TV, Hannigan EV, Doherty MG, Yandell RB, Buchanan VS. Management of patients with positive margins after cervical conization. Obstet Gynecol. 1993;82(3):440-443.
15. Murdoch JB, Morgan PR, Lopes A, Monaghan JM. Histological incomplete excision of CIN after large loop excision of the transformation zone (LLETZ) merits careful follow up, not retreatment. Br J Obstet Gynaecol. 1992;99(12):990-993.
16. Monk A, Pushkin SF, Nelson AL, Gunning JE. Conservative management of options for patients with dysplasia involving endocervical margins of cervical cone biopsy specimens. Am J Obstet Gynecol. 1996;174(6):1695-1699; discussion 1699-1700.
17. Paraskevaidis E, Arbyn M, Sotiriadis A, et al. The role of HPV DNA testing in the follow-up period after treatment for CIN: a systematic review of the literature. Cancer Treat Rev. 2004;30(2):205-211.