Predictive Value of Cervical Cone Biopsy Margins and Endocervical Curettage Results on Persistence of Residual Cervical Neoplasia in Subsequent Hysterectomy Specimens
Benjamin Mathis, Virginia A LiVolsi. University of Pennsylvania, Philadelphia, PA
Background: We studied the value of margins assessment for cervical cone biopsy specimens and of concurrent endocervical curettage (ECC) results to predict the presence of residual neoplasia in the hysterectomy. Confounding variables may include the type of excisional biopsy performed, i.e, cold-knife cone (CKC) or loop electrical excision procedure (LEEP), and type of neoplasia, i.e, glandular or squamous. We also analyzed the results based on the aforementioned confounding variables.
Design: We performed a retrospective review of records from January 1996-October 2010 of 217 women with a diagnosis of squamous or glandular cervical neoplasia in a cone biopsy. These subjects all subsequently underwent total hysterectomy within 11 years of the diagnosis (range: 2 days-11 years, median: 54 days, mean: 201 days).
Results: Of the 217 women meeting the criteria, 13 had both squamous and glandular neoplasia and were counted in both categories. ECC was performed at the time of cone biopsy in 154 cases. Among patients with involved margins, residual neoplasia was found in 53% of those with squamous neoplasia versus 62% of those with glandular neoplasia. Among patients with negative margins, residual neoplasia was identified more frequently in the glandular group (53%) than in the squamous group (31%). Stratification based on the type of excision did not affect the outcome. Additionally, patients with neoplasia on concurrent ECC were 3.0 (squamous) and 1.7 (glandular) times as likely to have residual neoplasia compared to those with negative ECCs (p<0.01 and p=0.03, respectively). Among patients with negative ECCs, those with a diagnosis of glandular dysplasia on concurrent cone biopsy were 2.0 times as likely to have residual neoplasia compared to patients with squamous neoplasia (p=0.01). Lastly, among patients who had margin involvement by squamous neoplasia, those who also had a positive ECC were 3.8 times as likely to have residual neoplasia compared to those with a negative ECC (p<0.01).
Conclusions: Our data is in accord with prior literature showing residual glandular neoplasia to be more frequent than residual squamous neoplasia despite negative margins on cone biopsy. Our study suggests that neoplasia found in a concurrent ECC is an important predictor of residual neoplasia and may ultimately prove to be of greater prognostic value than the cone biopsy margins. Finally, the modality of excisional biopsy did not significantly affect the frequency of residual disease.
Category: Gynecologic & Obstetrics
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 170, Monday Morning