THE MANAGEMENT AND FOLLOW-UP OF PATIENTS WITH HIGH-GRADE CERVICAL GLANDULAR INTRAEPITHELIAL NEOPLASIA

The purpose of this study was to evaluate if the status of the margins on large loop excision of the transformation zone (LLETZ) can predict the presence of residual cervical glandular intraepithelial neoplasia (CGIN) and to assess the efficacy of cervical conization as primary m anagement of CGIN. between January 1989 and March 1997 fifty patients with a diagnosis of CGIN made by LLETZ were treated in the Department of Gynaecological Oncology at the Queen Elizabeth Hospital, Gateshead. Presence or absence of CGIN at cone margins, results of cervical cyto logical examinations before and following conization, colposcopic exam ination, and results of histopathologic assessment of any surgical spe cimens taken after initial cone biopsy were analyzed in this study. Of the 50 patients with CGIN, managed by conization, in 34 (68%) CGIN wa s present at the surgical margins and in 16 (32%) the margins were cle ar. Eleven (32.3%) patients with CGIN at the margins of excision had e vidence of residual disease and there was only one of the 16 (6.25%) p atients with clear margins (P = 0.03). Two cases of invasive adenocarc inoma were identified in the group of patients with positive margins. In a mean follow-up time of 32.35 months, no case of invasive carcinom a was identified in the completely excised group. In our retrospective study LLETZ was found to be an adequate primary management for CGIN, and the excision margin status of the LLETZ specimen did appear to be a prognostic factor for residual disease.