The incomplete cone biopsy: a comparison of conservative and surgical management

Watson, Alan J.; Tuffnell, Derek; Lowe, Janell; Rand, R J; Wilkinson, Katheryn Hope

doi:10.1016/0028-2243(93)90023-6

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…In this study, the rate of recurrent disease in patients with positive margin who underwent regular follow-up after initial LEEP was 17.6%, which was consistent with previous studies with a rate of 9.3% to 21.7%. [ 6 , 8 , 17 ] The difference in the recurrence rates with the literature is possibly due to the diversity in the definitions of recurrent disease and the various durations of follow-up. In our research, we divided the pre-LEEP TCT results into 2 groups: ≤ LSIL and ≥ASC-H, and by the statistical analysis we found that ≥ASC-H in the pre-LEEP TCT was a significant predictive risk factor for recurrent disease.…”

Section: Discussionmentioning

confidence: 99%

“…Some assume that follow-up protocol is the ideal way for management of positive margin, [14] while others prefer a second surgical intervention such as repeat conization or hysterectomy. [3,11,[15][16][17] As for the management of positive margins, both over-treatment and insufficient treatment should be avoided. [18] Accordingly, many studies have focused on identifying the risk factors for residual and recurrent disease in patients with positive margin, such as age, menopausal status, TCT results, HPV infection, and the pathological characteristics of the conization specimens.…”

Section: Discussionmentioning

confidence: 99%

“…The management of positive margins has been controversial among researchers. Some assume that follow-up protocol is the ideal way for management of positive margin, [14] while others prefer a second surgical intervention such as repeat conization or hysterectomy [3,11,15–17] . As for the management of positive margins, both over-treatment and insufficient treatment should be avoided [18] .…”

Section: Discussionmentioning

confidence: 99%

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Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization

Abdulaziz¹,

You²,

Liu³

et al. 2021

Medicine

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To explore the optimal way to manage patients with high-grade squamous intraepithelial lesion (HSIL) and positive margin by identifying the risk factors for its recurrence and residue. A retrospective study was conducted on 267 cases of a pathologically confirmed HSIL with positive margin following conization by loop electrosurgical excisional procedure (LEEP) between January 2010 and December 2015. One hundred two cases were selected for regular follow-up every 6 months, and 165 cases were selected for a second surgery (repeat cervical conization or hysterectomy) within 3 months of initial LEEP. We analyzed the association between recurrent or residual diseases and these factors: age, menopausal status, ThinPrep cytologic test (TCT) results, high-risk human papillomavirus (HR-HPV) infection, pathological grades of the margin, number of involved margins, and glandular involvement. The recurrence rate among 102 cases who underwent follow-up was 17.6% (18/102). The factors: atypical squamous cells of undetermined significance cannot exclude HSIL (ASC-H) or higher lesions in the pre-LEEP TCT ( P = .038), persistent HR-HPV infection at the 6th month post-LEEP ( P = .03), HSIL-positive margin ( P = .003), and multifocal-involved margin ( P = .002) were significantly associated with recurrent disease, while age, menopause, and pre-LEEP HR-HPV infection were not associated with recurrent disease ( P > .05). The residual rate among 165 patients who underwent a second surgery was 45.5% (75/165), of which 15 cases were residual cervical cancer. The factors: menopause ( P = .02), ≥ASC-H in pre-LEEP TCT ( P = .04), pre-LEEP HR-HPV infection ( P = .04), ≥HSIL-positive margin ( P < .001), and multifocal-involved margin ( P < .001) significantly increased the risk of residual disease. No correlation existed between residual disease and age or glandular involvement ( P > .05). For patients with a positive margin after LEEP, regular follow-up or second surgery should be selected according to fertility requirement and pathological characteristics of the positive margin, as well as TCT and HR-HPV infection condition.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization

Abdulaziz¹,

You²,

Liu³

et al. 2021

Medicine

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“…[ 4 ] When positive margin exists, there are 3 management options: TCT, HPV, and colposcopic in close follow-up; repeat conization (including CKC and LEEP again); and hysterectomy. [ 11 , 12 ] The choice making is mainly influenced by the patients’ demand for fertility, age, compliance of follow-up, and the probability of residual disease. The probability of residual lesions and recurrent lesions is a focus of attention for patients and doctors.…”

Section: Discussionmentioning

confidence: 99%

“…There are 3 management options: thinprep cytologic test (TCT), HPV, and colposcopic in close follow-up; repeat conization and hysterectomy. [ 11 , 12 ]…”

Section: Introductionmentioning

confidence: 99%

The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization

et al. 2018

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The aim of this study was to illuminate risks factors of residual lesions, and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive margin who underwent cervical conization.A retrospective cohort study of 218 patients with positive margin after conization, including cold knife conization (CKC) and loop electrosurgical excisional procedure (LEEP), and follow-up from 2013 through 2016. The diagnosis of residual disease and recurrence were established and confirmed by biopsy. We evaluate the correlations among residual rate, recurrence rate, and clinical parameters, such as age, menopausal status, gravity, parity, glandular involvement, thinprep cytologic test (TCT), and human papillomavirus (HPV) results. We also detect the difference between CKC and LEEP.There was statistical difference between the positive margin rate of CKC group and LEEP regarding the surgery methods (5.8% and 12.09% separately, P < .001). Residual disease was found in 53.66% cases where 41 patients received second surgery after conization. Besides, age (P = .027), menopausal status (P = .006), and HPV infection (P = 0.018) were significantly associated with residual lesion. Among 177 cases with histopathologic follow-up, 15.91% women relapsed from 4 to 27 months. As for recurrence we found it was more frequent with HPV infection and glandular involvement (P < .001). TCT was also an independent factor in patients with recurrence of lesion. No evidence shows difference between CKC and LEEP for recurrence rate (P = .918).The factors related to rate of residual lesion were age, menopausal status, and HPV infection. HPV infection, TCT, and glandular involvement were associated with HSIL recurrence. LEEP was as effective as CKC with regard to recurrence rate. Further large-scale studies are needed to confirm our findings.

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Combined Colposcopy, Loop Conization, and Laser Vaporization Reduces Recurrent Abnormal Cytology and Residual Disease in Cervical Dysplasia

Bar‐Am¹,

Daniel²,

Ron³

et al. 2000

Gynecologic Oncology

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The incomplete cone biopsy: a comparison of conservative and surgical management

Cited by 6 publications

References 8 publications

Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization

Management of high-grade squamous intraepithelial lesion patients with positive margin after LEEP conization

The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization

Combined Colposcopy, Loop Conization, and Laser Vaporization Reduces Recurrent Abnormal Cytology and Residual Disease in Cervical Dysplasia

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