PREDICTION OF RESIDUAL NEOPLASIA BASED ON HISTOPATHOLOGY AND MARGIN STATUS OF CONIZATION SPECIMENS

Objective: To evaluate the status of cone margins and the severity of cervical neoplasia as predictors of residual lesions in the remaining cervices. Methods: We performed a 7-year retrospective study and revie wed 172 patients who had undergone cervical conization followed by sub sequent hysterectomy. Pathological findings of the cone margins and re sidual lesions in the postcone hysterectomy specimens were recorded fo r analysis. Results: The prevalence rates of positive cone margins wer e 0, 18.6, 23.8, and 25%, respectively, in patients with low-grade squ amous intraepithelial lesion (SIL) (n = 6), high-grade SIL (n = 129), stage IA1 cervical cancer (CC-IA1) (n = 21), and CC-IA2 (n = 16). The prevalence rates of positive residual lesions in postcone hysterectomy specimens were 0, 23.3, 23.8, and 43.88, respectively, in those with low-grade SIL, high-grade SlL, CC-IA1, and CC-IA2. Residual lesions we re significantly more frequently found in patients with positive cone margins (84.81) than in those with negative margins (10.1%) (chi(2) = 76.81, P < 0.0001). All six patients with low-grade SIL had free cone margins. Positive predictive values of margin status for the presence of residual lesions were 83.3, 80, and 100%, respectively, in patients with high-grade Sa, CC-IA1, aid CC-IA2. Only two (6.1%) of 33 patient s with positive cone margins had more advanced residual lesions. Negat ive predictive values of margin status for the absence of residual les ions were 100, 90.5, 93.8, and 75%, respectively, in patients with low -grade SIL, high-grade SIL, CC-IA1, and CC-IA2. None of the 139 patien ts with negative margins had invasive residual lesion. Conclusions: (1 ) The prevalence of positive cone margin and residual lesion increased with higher severity of cervical neoplasia. (2) Patients with positiv e cone margins had significantly higher chances of having residual les ion than those with negative margins. (3) Free cone margin does not en sure the absence of residual lesion in the remaining cenix However, th e possibility of residual invasive cancer in the remaining cervix is r emote. (4) Positive cone margin does not invariably indicate the prese nce and persistence of more severe residual lesion. Subsequent hystere ctomy may be reserved for the patient with invasive cone pathology, th e patient with concomitant morbid uterine condition, or the patient wh o is not reliable for continuous follow-up. (C) 1996 Academic Press, I nc.