Positive Margin Status in Uterine Cervix Cone Specimens Is Associated with Persistent/Recurrent High-Grade Dysplasia
Ruthy Shaco-Levy, Gilad Eger, Jacob Dreiher, Daniel Benharroch, Mihai Meirovitz. Soroka University Medical Center, Beer-Sheva, Israel; Ben-Gurion University of the Negev, Beer-Sheva, Israel; Clalit Health Services, Tel-Aviv, Israel
Background: The frequency of positive cone margins and its significance in cervical intraepithelial neoplasia (CIN) are under controversy. The purpose of the current study was to identify factors associated with positive cone margin status and to evaluate its clinical significance in high-grade CIN.
Design: Medical records of women who underwent loop electrosurgical excision procedure at Soroka University Medical Center (January 2001 - July 2011) were reviewed retrospectively. Patient age, extent of dysplasia, endocervical glands involvement, positive margin status, type of margin involved, degree of margin involvement, and post-cone endocervical curettage results were evaluated as possible factors associated with persistent/recurrent disease.
Results: Three hundred seventy six women were included in the study. Cone margin involvement was observed in 33% (endocervical – 22%, ectocervical -8%, both margins – 3%). Factors significantly associated with cone margin involvement were older age (>35 years), widespread dysplasia in the cone specimen (≥4 sections) (p<0.001 for each) and endocervical glands involvement (p=0.003). Fifty patients (13%) had persistent/recurrent disease. Involvement of the cone margins (focal: HR=17, p<0.001; extensive: HR=28, p<0.001) and older age (HR = 1.18 for every five additional years, p=0.03) were associated with persistent/recurrent disease.
Conclusions: We conclude that women older than 35 years with widespread high-grade dysplasia in the cone specimen and involvement of endocervical glands are more likely to have positive cone margins. Positive cone margins, particularly when extensively involved, as well as increased patient age are associated with persistent/recurrent disease. These factors should be considered when planning further management.
Category: Gynecologic & Obstetrics
Wednesday, March 6, 2013 1:00 PM
Poster Session VI # 187, Wednesday Afternoon