P. Vedel et al., 5-YEAR FOLLOW-UP OF PATIENTS WITH CERVICAL INTRAEPITHELIAL NEOPLASIA IN THE CONE MARGINS AFTER CONIZATION, European journal of obstetrics, gynecology, and reproductive biology, 50(1), 1993, pp. 71-76
Three hundred eighty-five women treated with conization due to repeate
d CIN I, CIN II or CIN III of the cervix uteri have been followed up f
or 5 years. All cones were classified according to diagnosis and statu
s of the resection margins. A significantly greater recurrence rate of
16.2% was found in the group with neoplasia in the resection margins,
in contrast to 3.9% in the group with normal resection margins. Howev
er, 83.8% (75.4-92.2%) of patients with neoplasia in the resection mar
gins can be expected to be free of recurrence after a 5-year postopera
tive follow-up period. Whether the non-free resection margins were end
ocervical, ectocervical or both, did not influence the recurrence rate
. While the prevalence of non-free resection margins increased signifi
cantly with increasing dysplasia, this could not be found with increas
ing age. The risk of recurrence could not be correlated with the grade
of dysplasia. We conclude that neoplasia in the resection margins of
the cone represents an increased risk of recurrence. Therefore, we cha
nged the normal smear check-up with a cotton-swab to smear with cyto-b
rush, supplemented with colposcopy in the non-free resection margin gr
oup, but it remains to be proven that this procedure is safer.