1. Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China 2. Key Laboratory of Women’s Reproductive Health of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China 3. Department of Obstetrics & Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400000, China 4. Ningbo No.2 Hospital, Ningbo 315000, China
The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion (HSIL) patients with positive margin by conization. Clinico-pathological data of HSIL patients with positive margin by conization were retrospectively collected from January 2009 to December 2014. All patients underwent secondary conization or hysterectomy within 6 months. The rate of residual lesion was calculated, and the factors associated with residual lesion were analyzed by univariate and multivariate analyses. Among a total of 119 patients, 56 (47.06%) patients presented residual HSIL in their subsequent surgical specimens, including 4 cases of invasive cervical carcinoma (3 stage IA1 and 1 stage IA2 patients). Univariate analysis showed that patient age>35 years (P=0.005), menopausal period>5 years (P=0.0035), and multiple-quadrant involvement (P=0.001) were significantly correlated with residual disease; however, multivariate analysis revealed that multiple-quadrant involvement (P=0.001; OR, 3.701; 95%CI, 1.496–9.154) was an independent risk factor for residual disease. Nearly half of HSIL patients with positive margin by conization were disease-free in subsequent surgical specimens, and those with multiple positive margins may consider re-conization or re-assessment.
Fitzmaurice C, Dicker D, Pain A, Hamavid H, Moradi-Lakeh M, MacIntyre MF, Allen C, Hansen G, Woodbrook R, Wolfe C, Hamadeh RR, Moore A, Werdecker A, Gessner BD, Te Ao B, McMahon B, Karimkhani C, Yu C, Cooke GS, Schwebel DC, Carpenter DO, Pereira DM, Nash D, Kazi DS, De Leo D, Plass D, Ukwaja KN, Thurston GD, Yun Jin K, Simard EP, Mills E, Park EK, Catalá-López F, deVeber G, Gotay C, Khan G, Hosgood HD III, Santos IS, Leasher JL, Singh J, Leigh J, Jonas JB, Sanabria J, Beardsley J, Jacobsen KH, Takahashi K, Franklin RC, Ronfani L, Montico M, Naldi L, Tonelli M, Geleijnse J, Petzold M, Shrime MG, Younis M, Yonemoto N, Breitborde N, Yip P, Pourmalek F, Lotufo PA, Esteghamati A, Hankey GJ, Ali R, Lunevicius R, Malekzadeh R, Dellavalle R, Weintraub R, Lucas R, Hay R, Rojas-Rueda D, Westerman R, Sepanlou SG, Nolte S, Patten S, Weichenthal S, Abera SF, Fereshtehnejad SM, Shiue I, Driscoll T, Vasankari T, Alsharif U, Rahimi-Movaghar V, Vlassov VV, Marcenes WS, Mekonnen W, Melaku YA, Yano Y, Artaman A, Campos I, MacLachlan J, Mueller U, Kim D, Trillini M, Eshrati B, Williams HC, Shibuya K, Dandona R, Murthy K, Cowie B, Amare AT, Antonio CA, Castañeda-Orjuela C, van Gool CH, Violante F, Oh IH, Deribe K, Soreide K, Knibbs L, Kereselidze M, Green M, Cardenas R, Roy N, Tillmann T, Li Y, Krueger H, Monasta L, Dey S, Sheikhbahaei S, Hafezi-Nejad N, Kumar GA, Sreeramareddy CT, Dandona L, Wang H, Vollset SE, Mokdad A, Salomon JA, Lozano R, Vos T, Forouzanfar M, Lopez A, Murray C, Naghavi M; Global Burden of Disease Cancer Collaboration. The global burden of cancer 2013. JAMA Oncol 2015; 1(4): 505–527 https://doi.org/10.1001/jamaoncol.2015.0735
2
Goldie SJ, Kohli M, Grima D, Weinstein MC, Wright TC, Bosch FX, Franco E. Projected clinical benefits and cost-effectiveness of a human papillomavirus 16/18 vaccine. J Natl Cancer Inst 2004; 96(8): 604–615 https://doi.org/10.1093/jnci/djh104
3
Tasci T, Turan T, Ureyen I, Karalok A, Kalyoncu R, Boran N, Tulunay G. Is there any predictor for residual disease after cervical conization with positive surgical margins for HSIL or microinvasive cervical cancer? J Low Genit Tract Dis 2015; 19(2): 115–118 https://doi.org/10.1097/LGT.0000000000000079
4
Ghaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol 2007; 8(11): 985–993
5
Chambo Filho A, Garbeloto E, Guarconi JR, Partele MP. Positive endocervical margins at conization: repeat conization or colposcopic follow-up? a retrospective study. J Clin Med Res 2015; 7(7): 540–544 https://doi.org/10.14740/jocmr2171w
6
dos Santos Melli PP, Duarte G, Quintana SM.Multivariate analysis of risk factors for the persistence of high-grade squamous intraepithelial lesions following loop electrosurgical excision procedure. Int J Gynaecol Obstet 2016; 133(2): 234–237 https://doi.org/10.1016/j.ijgo.2015.09.020
7
Fonseca FV, Tomasich FD, Jung JE. High-grade intraepithelial cervical lesions: evaluation of the factors determining an unfavorable outcome after conization. Rev Bras Ginecol Obstet 2011; 33(11): 334–340
8
Oliveira CA, Russomano FB, Gomes Júnior SC, Corrêa FM. Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis. Sao Paulo Med J 2012; 130(2): 119–125 https://doi.org/10.1590/S1516-31802012000200009
9
Tan XJ, Wu M, Lang JH, Ma SQ, Shen K, Yang J. Predictors of residual lesion in cervix after conization in patients with cervical intraepithelial neoplasia and microinvasive cervical cancer. Natl Med J China (Zhonghua Yi Xue Za Zhi) 2009; 89(6): 17–20 (in Chinese)
pmid: 19489237
10
Andrade CE, Scapulatempo-Neto C, Longatto-Filho A, Vieira MA, Tsunoda AT, Da Silva ID, Fregnani JH. Prognostic scores after surgical treatment for cervical intraepithelial neoplasia: a proposed model and possible implications for post-operative follow-up. Acta Obstet Gynecol Scand 2014; 93(9): 941–948 https://doi.org/10.1111/aogs.12446
11
Del Mistro A, Matteucci M, Insacco EA, Onnis GL, Da Re F, Baboci L, Zorzi M, Minucci D. Long-term clinical outcome after treatment for high-grade cervical lesions: a retrospective monoinstitutional cohort study. BioMed Res Int 2015; 2015:984528 https://doi.org/10.1155/2015/984528
pmid: 26180819
12
Sangkarat S, Ruengkhachorn I, Benjapibal M, Laiwejpithaya S, Wongthiraporn W, Rattanachaiyanont M. Long-term outcomes of a loop electrosurgical excision procedure for cervical intraepithelial neoplasia in a high incidence country. Asian Pac J Cancer Prev 2014; 15(2): 1035–1039 https://doi.org/10.7314/APJCP.2014.15.2.1035
13
Ryu A, Nam K, Chung S, Kim J, Lee H, Koh E, Bae D. Absence of dysplasia in the excised cervix by a loop electrosurgical excision procedure in the treatment of cervical intraepithelial neoplasia. J Gynecol Oncol 2010; 21(2): 87–92 https://doi.org/10.3802/jgo.2010.21.2.87
14
Wu J, Jia Y, Luo M, Duan Z. Analysis of residual/recurrent disease and its risk factors after loop electrosurgical excision procedure for high-grade cervical intraepithelial neoplasia. Gynecol Obstet Invest 2016; 81(4): 296–301 https://doi.org/10.1159/000437423
15
Ramchandani SM, Houck KL, Hernandez E, Gaughan JP. Predicting persistent/recurrent disease in the cervix after excisional biopsy. MedGenMed 2007; 9(2): S1-24
16
Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, Solomon D, Wentzensen N, Lawson HW. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis 2013; 17(5): S1–27 https://doi.org/10.1097/LGT.0b013e318287d329
17
Kietpeerakool C, Khunamornpong S, Srisomboon J, Siriaunkgul S, Suprasert P. Cervical intraepithelial neoplasia II–III with endocervical cone margin involvement after cervical loop conization: is there any predictor for residual disease? J Obstet Gynaecol Res 2007; 33(5): 660–664 https://doi.org/10.1111/j.1447-0756.2007.00628.x
18
Fu Y, Chen C, Feng S, Cheng X, Wang X, Xie X, Lü W. Residual disease and risk factors in patients with high-grade cervical intraepithelial neoplasia and positive margins after initial conization. Ther Clin Risk Manag 2015; 11: 851–856 https://doi.org/10.2147/TCRM.S81802
19
Siriaree S, Srisomboon J, Kietpeerakool C, Khunamornpong S, Siriaunkgul S, Natpratan A, Pratheapjarus S, Futemwong A, Chantarasenawong U. High-grade squamous intraepithelial lesion with endocervical cone margin involvement after cervical loop electrosurgical excision: what should a clinician do? Asian Pac J Cancer Prev 2006; 7(3): 463–466
20
Verguts J, Bronselaer B, Donders G, Arbyn M, Van Eldere J, Drijkoningen M, Poppe W. Prediction of recurrence after treatment for high-grade cervical intraepithelial neoplasia: the role of human papillomavirus testing and age at conisation. BJOG 2006; 113(11): 1303–1307 https://doi.org/10.1111/j.1471-0528.2006.01063.x
Leiman G, Harrison NA, Rubin A. Pregnancy following conization of the cervix: complications related to cone size. Am J Obstet Gynecol 1980; 136(1): 14–18 https://doi.org/10.1016/0002-9378(80)90556-6
23
Luesley DM, Mccrum A, Terry PB, Wade-Evans T, Nicholson HO, Mylotte MJ, Emens JM, Jordan JA. Complications of cone biopsy related to the dimensions of the cone and the influence of prior colposcopic assessment. Br J Obstet Gynaecol 1985; 92(2): 158–164 https://doi.org/10.1111/j.1471-0528.1985.tb01068.x
24
Castanon A, Brocklehurst P, Evans H, Peebles D, Singh N, Walker P, Patnick J, Sasieni P. Risk of preterm birth after treatment for cervical intraepithelial neoplasia among women attending colposcopy in England: retrospective prospective cohort study. BMJ 2012; 345:e5174
25
Kyrgiou M, Arbyn M, Martin-Hirsch P, Paraskevaidis E. Increased risk of preterm birth after treatment for CIN. BMJ 2012; 345(3): 195–204
26
Bruinsma F, Lumley J, Tan J, Quinn M. Precancerous changes in the cervix and risk of subsequent preterm birth. Br J Obstet Gynaecol 2007; 114(1): 70–80 https://doi.org/10.1111/j.1471-0528.2006.01107.x
27
Esmyot ML, Mahran M, Worcester B, Chan M, Patil D, Kiani M, Chidothe N. Cervical surgery for cervical intraepithelial neoplasia and prolonged time to conception of a live birth: a case-control study. BJOG 2013; 120 (8): 960–965
28
Ayhan A, Tuncer HA, Reyhan NH, Kuscu E, Dursun P. Risk factors for residual disease after cervical conization in patients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins. Eur J Obstet Gynecol Reprod Biol 2016; 201: 1–6 https://doi.org/10.1016/j.ejogrb.2016.03.021
29
Zhu MH, He Y, Baak JP, Zhou XR, Qu YQ, Sui L, Feng WW, Wang Q. Factors that influence persistence or recurrence of high-grade squamous intraepithelial lesion with positive margins after the loop electrosurgical excision procedure: a retrospective study. BMC Cancer 2015; 15(1): 744–754 https://doi.org/10.1186/s12885-015-1748-1
30
Kang WD, Ju UC, Mo KS. A human papillomavirus HPV-16 or HPV-18 genotype is a reliable predictor of residual disease in a subsequent hysterectomy following a loop electro-surgical excision procedure for cervical intraepithelial neoplasia 3. J Gynecol Oncol 2015; 275(35): 27221–27228
31
Diaz ES, Aoyama C, Baquing MA, Beavis A, Silva E, Holschneider C, Cass I. Predictors of residual carcinoma or carcinoma-in-situ at hysterectomy following cervical conization with positive margins. Gynecol Oncol 2014; 132(1): 76–80 https://doi.org/10.1016/j.ygyno.2013.11.019
