The risk of residual neoplasia in women with microinvasive squamous cervical carcinoma and positive cone margins

Abstract

The objective was to evaluate the prevalence and factors affecting residual disease in women with cervical microinvasive carcinoma (MIC) with positive cone margins for high-grade lesions and invasive carcinoma. We reviewed histopathology slides of 129 women with MIC who had high-grade lesions or invasive carcinoma at cone margins. These patients underwent hysterectomy following cone biopsy between January 1994 and June 2004. Of the 129 patients, 77 (59.7%) had residual disease in the hysterectomy specimens, in which 57 (44.2%) had residual high-grade lesions. Twenty patients (15.5%) had residual invasive carcinoma: 18 were microinvasive and 2 were invasive. Factors significantly affecting the risk of residual disease included positive postconization endocervical curettage (P= 0.001), positive cone margins for invasive carcinoma (P= 0.003), and depth of stromal invasion >1 mm (P= 0.014). Cox proportional hazards analysis revealed positive cone margins for invasive carcinoma as significant predictor of residual invasive disease (hazard ratio, 3.22; 95% CI 1.21-8.60, P= 0.019) In summary, patients with MIC and positive cone margins for high-grade lesions or invasive carcinoma are at high risk of residual neoplasia. Repeat cone biopsy should be performed to determine exactly the severity of lesion before planning treatment.

The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: Background and Consensus Recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology

“…Persistent or recurrent cervical disease may occur in women with negative margins or those involved by SIL, and both groups remain at risk for persistent or recurrent SIL [98]. Women with involved margins are at increased risk for both the presence of multifocal invasive squamous carcinoma and persistent SIL [96,137,[139][140][141][142][143]. Clinical follow-up or immediate reexcision may be chosen in the management of women with SIL at the surgical margins.…”

Conservative management of stage IA1 squamous cell carcinoma of the cervix with positive resection margins after conization

“…However, concerns remain about residual disease and risk of persistence or recurrence when treating these patients with conization alone. Studies reporting the results of repeat conization or hysterectomy showed that the risk of residual neoplasia was higher when the conization specimen had positive internal margins [5,6]. As such, the margin status of the cone biopsy specimen has become important in determining the adequacy of treatment [16] and is thought to be a significant prognostic factor [5,17].…”

“…Studies reporting the results of repeat conization or hysterectomy showed that the risk of residual neoplasia was higher when the conization specimen had positive internal margins [5,6]. As such, the margin status of the cone biopsy specimen has become important in determining the adequacy of treatment [16] and is thought to be a significant prognostic factor [5,17]. Paterson-Brown et al [17] reported that the incidence of residual disease was 12% for patients with negative resection margins compared with 82% for patients with positive resection margins.…”

“…The risk of residual neoplasia is higher when the resection margin of the conization specimen is positive for high-grade lesion [5], and further treatment such as hysterectomy has been performed in these patients [6,7]. As such, further treatment for residual neoplasia can be seen to depend on the margin status of the conization specimen [6,8].…”

Residual Disease Following Conization of Women with Stage IA-IB1 Cervical Carcinoma in a High Incidence Region

“…When compared stage by stage with previous studies, the current study had higher prevalence of residual CIN or cancer. This might be from higher rate of cervical neoplasia at conization margins, as a study of 129 patients with stage IA1 SCCA with positive cone margins that residual high-grade CIN and cancer were found in 44.2% and 15.5% of cases (Phongnarisorn et al, 2006).…”