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

Abstract

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.

See and treat strategy by LEEP conization in patients with abnormal cervical cytology

“…They also showed that the need for multiple sweeps during LEEP was the most important predictor of disease persistence [24]. We know that LEEP is associated with higher rates of positive surgical margin in lesions involving more than two-third of the cervix compared to cold-knife conization [25]. As an indicator of number of sweeps, the number of fragments of LEEP was not associated with surgical margin positivity in our study.…”

How to optimize excisional procedures for the treatment of CIN? The role of colposcopy

“…After multivariate analysis, both the size of the abnormal TZ and the excisional technique were identified as the two factors having a significant and independent impact on the risk of involved resection margins. Thus, consistent with a previous study [25], the probability of negative margins was significantly higher among patients who underwent CNC. This is likely to be explained by the ability of CNC to simultaneously achieve significantly deeper and larger excision and therefore a higher excised volume.…”

Prediction, based on resection margins, of long-term outcome of cervical intraepithelial neoplasia 3 treated by Shimodaira-Taniguchi conization

“…However, others have found that the resection margin of CIN lesions produced by LEEP, cold knife, or laser was demonstrated to be able to aid in predicting the subsequent recurrence of CIN 3 [7,8]. According to Chen et al, the persistence/recurrence rate of margin-positive cases, 33% (47/141 cases), was significantly higher than that of the margin-negative cases, 2% (21/972 cases) (p \ 0.0001 by Fisher's exact test).…”

“…In addition, the median follow-up period was not reported in their analysis. The long-term cumulative persistence/recurrence rate, the most important outcome measure of conservative treatment for any pre-malignant lesions, was demonstrated in their report; however, the rate was not compared by the status of their resection margin data, which has been demonstrated elsewhere to be of significant value for the prediction of the outcome of conization procedures for CIN 3 [7,8]. In our present study, the long-term outcome of CIN 3 treated by Shimodaira-Taniguchi conization in our facility was re-analyzed by the status of their resection margins.…”

“…Among the 198 patients whose resection margin had been negative, persistence/recurrence was detected in 7 patients: cases 1, 2, 3, 4, 6, 7, and 8 (3.5%) (Tables 2, 3). Pathological diagnosis of the persistent/recurrent lesion was CIN 1 in three cases (cases 2, 6, 7), CIN 2 in one case (case 3), and CIN 3 in three cases (cases 1,4,8). Among these margin-negative cases, the first cytology exhibited normal appearance (NILM) and the CIN lesions were detected beyond the initial 3 months of observation (after 299-2,465 days from conization) in three cases (cases 6,7,8).…”