K. Holcomb et al., The efficacy of cervical conization in the treatment of cervical intraepithelial neoplasia in HIV-positive women, GYNECOL ONC, 74(3), 1999, pp. 428-431
Objective. The aim of this study was to evaluate the efficacy of cervical c
onization in the treatment of CM in HIV-positive women.
Materials and Methods. Sixty-six HIV-positive women treated with cervical c
onization for CIN were stratified into four groups based on surgical margin
and endocervical curetting (ECC) status (group 1: -margin/-ECC, group 2: margin/-ECC, group 3: +margin/+ECC, group 4: -margin/+ECC). The rate of his
tologically proven recurrent CIN was calculated for each group and compared
using chi(2) analysis. The effect of +margins, +ECC, degree of dysplasia,
and CD4 count on the risk of recurrence was determined by logistic regressi
on.
Results. Forty-nine percent of patients with negative margins and negative
ECC experienced recurrence, most within 36 months. There was no significant
difference in recurrence rate for patients with positive margins (69.2%, P
= 0.19), positive ECC (50%, P = 0.97), or positive margins and ECC (66.7%,
P = 0.41) when compared to patients with complete excision of dysplasia. N
o significant difference in the mean CD4 count of patients with and without
recurrent dysplasia (316 vs 390 cells/mm(3), P = 0.37) was observed. Logis
tic regression showed only degree of dysplasia in the cone specimen to have
a marginally significant linear relationship with recurrence.
Conclusion. Cervical conization is not an effective method for eradicating
CIN in HIV-positive women. Most patients will recur despite complete excisi
on of dysplasia. Surgical margin status, ECC status, and CD4 count appear t
o have no effect on recurrence rate. Although multiple procedures were nece
ssary in some patients, cone biopsy was effective in preventing progression
to invasive cervical cancer in all cases. (C) 1999 Academic Press.