Importance of surgical margins in conization for cervical intraepithelial neoplasia grade III

Abstract

We conducted a retrospective study on 201 conizations for CIN III done over the last 14 years. Of these, 53 (26.4%) had involvement of the margins, 114 (56.7%) had margins free of neoplasia, and 34 (16.9%) were not evaluated. Of the 53 cases with margin involvement, 28 (52.8%) had complementary surgery and 25 (47.2%) cytological follow-up. Residual CIN was identified in the surgical specimen in 15 cases (53.6%) and microinvasion was present in 2 cases (7.1%). Of the 114 patients with margins free of neoplasia in the cone, 12 had a hysterectomy during follow-up for CIN III diagnosed by cytology and biopsy. Seven of these 12 patients (58.3%) had CIN in the surgical specimen and none had microinvasive cancer.

Endocervical glandular involvement, multicentricity, and extent of the disease are features of high-grade cervical intraepithelial neoplasia

“…In a previous report, 38% of women with positive endocervical LEEP margins had residual disease detected at hysterectomy [15]. Patients with negative LEEP margins were also reported to recur [16], but recurrence rates were 4 times higher when the surgical margins were positive when compared with negative margins [17]. On the other hand, Livasy et al [8] reported no difference in recurrence rates of patients with and without positive margins.…”

Cervical intraepithelial neoplasia recurrence after conization in HIV‐positive and HIV‐negative women

“…Tissue destroyed by LEEP and hemostatic cauterization could contribute to a lower recurrence rate [19]. Nevertheless, free lesion margins do not exclude recurrence [5,20]. A controversy exists regarding the use of a second loop during the surgical procedure in more severe lesions with a nonvisible squamous cervical junction [6].…”

“…Previous reports have identified margin status, endocervical extension, and multiquadrant disease as risk factors for recurrence [4]. Margin status is the risk factor investigated most frequently [5,6]. Livasy et al [7] reported a recurrence rate of 39% in women with positive margins after LEEP, compared with 15% in women with negative margins.…”

Prevalence of micronuclei in exfoliated uterine cervical cells from patients with risk factors for cervical cancer

“…Furthermore, the micronucleus test has been considered to be a very useful biomarker for detecting malignancy in the uterine cervix, with regard to other factors like surgical margins and the numbers of mitoses and methylated genes, for predicting recurrence of CIN III. [44][45][46] The number of micronuclei correlates with the severity of genetic damage. Cells containing several micronuclei present greater genetic damage than do cells that present only one micronucleus.…”