Background:Conization of cervix has been regarded as an appropriate procedure in the management of high-grade
CIN for both diagnostic and therapeutic purposes.Most high-grade CIN can be treated with conization as long as it can be ensured that the entire lesion has been removed.On the other hand, if high-grade CIN is present in the cone margins, there is the possibility that more advanced disease remains in the uterus. Among the demographic and clinic-pathologic factors that may predict residual disease after conization are age, menopause status, parity, severity of disease, surgical margin and endocervical gland involvement. It is unclear if all of these are actually risk factors and if the results of pre-cone high-risk HPV tests are predictive of residual disease. We therefore attempted to determine the factors predictive of post-cone residual disease in subsequent hysterectomy for CIN III.
Aim:To determine factors predicting post-cone residual disease in subsequent hysterectomy in CINIII.
Methods:Of 674 patients who underwent conization due to CIN III between Janury 2008 and December 2012, 142 underwent hysterectomy within a week of conization. We analyzed their demographic features, pathologic parameters, pre-cone high-risk HPV load and methods of conization.
Results:Age>40 years and conization method (LEEP vs.CKC) were not significant factors associated with residual disease. The incidence of residual disease was 64.1% and 39.06% in patients >40 and <40 years, and 54.76% and 37.5% in patients who received LEEP and CKC respectively. Positive pre-cone HR-HPV, positive margin and high-grade CIN in resection margin were significant factors associated with residual disease.
Conclusions:Positive pre-cone HR-HPV status and positive margin were significant factors predicting post-cone residual disease. Appropriate application of these predictive factors may lower the risk of residual disease. For patients with positive margin, especially high-grade CIN in resection margin, hysterectomy and follow-up examinations are appropriate options for this select group of women.