OUTCOMES AFTER CERVICAL COLD KNIFE CONIZATION WITH COMPLETE AND INCOMPLETE EXCISION OF ABNORMAL EPITHELIUM - A REVIEW OF 699 CASES

A retrospective analysis was undertaken of 699 cone biopsies performed at the Royal Women's Hospital in Melbourne from 1966 to 1992. In 572 cases (82%), abnormal epithelium was assessed as having been completel y excised, and in 127 (18%) excision was incomplete. There were no sig nificant differences in age, parity, cytology, histology, or indicatio ns for conization between patients in whom excision was incomplete and those in whom complete excision was achieved. Of the patients whose c one biopsy histology showed complete excision of abnormal epithelium, 96.7% were found to have been cured of disease on the basis of normal followup or normal histology of hysterectomy specimens. The overall cu re rate after incomplete cone biopsy was found to be 77%, but was infl uenced by the site of incomplete excision. The cure rate for incomplet e excision at the ectocervical margin was 86%; incomplete excision at the endocervix was 68% and only 40% if excision was incomplete at both edges. Cone biopsy undertaken for cervical intraepithelial neoplasia is likely to be curative when the lesion is completely excised, but re current disease may occur and adequate follow-up is an essential part of patient management after conization, regardless of histological fin dings in the conization specimen. Most cases of incompletely excised c ervical intraepithelial neoplasia will also be cured, especially if th e incomplete margin is ectocervical, and cytological and colposcopic f ollow-up may be an acceptable alternative to repeat cone biopsy or hys terectomy in the management of such cases. (C) 1997 Academic Press.