THE INCOMPLETE CONE BIOPSY - A COMPARISON OF CONSERVATIVE AND SURGICAL-MANAGEMENT

Objective: to determine the reliability of conservative management of cone biopsies showing apparently incomplete excision of cervical intra epithelial neoplasia (CIN) by comparing surgical and conservative mana gement. Design: a retrospective study. Subjects: 74 consecutive cone b iopsies with a histology report of apparently incomplete excision of C IN 2 or CIN 3 from a series of 738 cone biopsies. Main outcome measure s: the presence of CIN at hysterectomy against the pick up rate in con servatively managed patients. Results: where excision appeared incompl ete at the ectocervix this was confirmed in 1 of 6 (16.7%) of patients managed surgically and 2 of 17 (11.8%) of patients managed conservati vely (P = 0.40). Where excision appeared incomplete at both endo- and ectocervix, 5 of 6 (83.3%) were confirmed to have incomplete excision in the surgical group, and 3 of 5 (60%) had further proven CIN in the conservative group (P = 0.34). Where excision appeared incomplete at t he endocervix only, this was confirmed in 7 of 22 (32%) of cases manag ed surgically, but only 2 of 18 (11.1%) of cases managed conservativel y had further proven CIN (P = 0.14). Combining all patients with incom plete excision at the endocervix irrespective of the ectocervix status revealed confirmation of residual CIN in 12 of 28 (42.9%) patients ma naged surgically and in 5 of 23 (21.7%) patients managed conservativel y (P = 0.097). Conclusions: management should depend on the site of th e apparent incomplete excision. Where excision appears incomplete at t he ectocervix only, cytological follow up should be employed. If the e ndocervix is involved, further excisional surgery may be more appropri ate.