Laser conization of cervical intraepithelial neoplasia grade 3: Free resection margins indicative of lesion-free survival

Background. Various grades of cervical intraepithelial neoplasia may occur following laser conization for grade 3 lesions. The aim of this study was t o assess lesion-free survival after laser conization in cases with / withou t free resection margins, and to test whether detection of human papillomav irus infection and/or p53 expression in the cone lesion were useful predict ors of lesion-free survival. Methods. In 598 women treated for cervical intraepithelial neoplasia grade 3 the state of the resection margins was recorded and related to the findin gs on follow-up, up to 15 years post-operatively. Lesion-free survival time s were analyzed by the Kaplan-Meier method. The presence/absence of human p apillomavirus infection and/or p53 expression In the primary lesion was inv estigated in every fifth case by in situ hybridization, and immunohistochem istry respectively. Results. Lesion-free survival was significantly more common after complete than incomplete excision of cervical intraepithelial neoplasia. In the latt er, lesions tended to appear shortly after surgery, indicating the presence of residual disease. The few lesions appearing later were evenly divided b etween those with and those without complete excision. The results of the h uman papillomavirus and p53 investigations added no further information. Conclusions. The presence of cervical intraepithelial neoplasia in the cone margin gives strong indication of potential treatment failure. In its abse nce laser conization is highly effective in the treatment of cervical intra epithelial neoplasia, and has the advantage of providing a specimen suitabl e for the necessary histological investigation.