Menopausal status is associated with a high risk for residual disease after cervical conization with positive margins

Abstract

Background We aimed to determine demographic and clinicopathological predictors for residual disease in women with cervical intraepithelial neoplasia (CIN 2/3) with endocervical cone margin involvement. Methods and findings A cross-sectional study was conducted. The eligible patients were women who underwent hysterectomy as a treatment option after having a positive endocervical margin for CIN 2/3 in cervix conization specimens from 2000 to 2015. The patients were divided into two groups based on the persistence of CIN 2/3 and absence of CIN 2/3 in hysterectomy specimens. Demographic, clinical and histology information were collected in both groups. A total of 80 patients were eligible for the study; 37 (46.3%) had no persistence of CIN 2/3 and 43 (53.7%) had persistence of CIN 2/3 in the hysterectomy specimens. Demographic, clinical, and cone specimen characteristics, and a visible squamocolumnar junction and type of conization were analyzed as possible risk factors for the presence of residual lesions at hysterectomy, and none of these variables were associated with residual disease. Menopausal status was strongly associated with a high risk of persistent residual disease 81.2% (OR 4.9, CI 1.27–18.9), P = 0.014. In the multivariate analysis, only a menopausal status ( P = 0.04) was associated with a high risk of persistent lesions. Conclusion This analysis found that menopausal status exhibited an important association with persistent residual disease. Menopausal women with endocervical margin involvement exhibit a greater than 80% risk of persistent lesions.

<p>Risk Factors for Residual Disease in Hysterectomy Specimens After Conization in Post-Menopausal Patients with Cervical Intraepithelial Neoplasia Grade 3</p>

“…Previous studies have reported that menopausal status and age are both associated with residual lesions after conization. 15 , 17 In the present study, in 56 (43.41%) post-menopausal women, residual disease was discovered in hysterectomy specimens, representing a rate higher than previously reported data in younger patients. This may be explained by the specific study population of post-menopausal women and the identification of residual lesions in the hysterectomy specimens.…”

“…Several previous studies have evaluated clinical and pathological predictors of the persistence of or residual CIN and cervical cancer. 3,[5][6][7][8][9][10][13][14][15][16][17] However, only a few studies have examined whole uterine specimens after hysterectomy 13 and have focused on post-menopausal patients alone. These studies differ from each other methodologically, including the study populations and analysis of variables.…”

“…12 Therefore, to make more appropriate management decisions in clinical practice, many researchers have investigated risk factors that may predict residual disease after treatment for CIN 2-3. 3,[5][6][7][8][9][10][13][14][15][16][17] Some have found that menopausal status 17 and older age (>45 years) 15 are associated with a higher risk for residual disease after cervical conization. This specific group of post-menopausal or older patients needs more attention during treatment.…”

Necessity for subsequent surgery in women of child-bearing age with positive margins after conization

“…The results of previous studies have suggested that the possible risk factors for residual lesions after cervical conization mainly include positive margins of the specimen, involvement of the lateral margin of the cervical canal, involvement of the lateral margin of the cervical canal and outer orifice, positive specimen from ECC, menopause, persistent infection of high-risk HPV after cervical conization, and decreased or suppressed immune function [ 13 , 14 ]. Many factors affect the condition of the margin after CKC, including age, menopausal status, glandular involvement, smoking, infection, training level of the operator, and other factors [ 15 , 16 ]. In this study, the clinicopathological characteristics of 1309 women of child-bearing age after initial CKC and 245 cases of women with positive margins who accepted subsequent surgery within three months were retrospectively analyzed.…”

Necessity for subsequent surgery in women of child-bearing age with positive margins after cold knife conization: A retrospective cohort study

“…[13,14] Many factors affect the condition of the margin after CKC, including age, menopausal status, glandular involvement, smoking, infection, training level of the operator, and other factors. [15,16] In this study, we retrospectively analyzed the clinicopathological characteristics of 1,309 women of child-bearing age after initial CKC and 245 cases of women with positive margins who accepted subsequent surgery within three months. We found that a major cytology abnormality (including HSILs and ASC-Hs), high-risk HPV infection type III transformation zone, positive ECC result, and multiple quadrant involvement were the common risk factors for positive margins and residual lesions.…”