Management of patients with positive margins after cervical conization.

Objective: To define recommended treatment in cases of positive margins on cone biopsy specimens. Patients and methods: This single-center retrospective study concerned 220 conizations performed between January 1996 and June 1998. The results of 70 conizations (31.8%) with positive margins were analysed. There were 32 col d knife conizations (mean age: 43 years) and 38 conizations by the loop ele ctrosurgical excision procedure (mean age: 33 years). Results: Mean depth of conization was 15.94 mm for cold knife conization an d 10.08 mm for loop electrosurgical conization. Fifteen patients were exclu ded (5 with invasive cancer and 10 were lost to follow-up). This study incl uded 55 patients with a mean 12-month follow-up. Six underwent hysterectomy for mini-invasion on the specimen or advanced age. Eleven underwent a seco nd conization (followed by hysterectomy in 2 cases). The other 38 patients were submitted to simple surveillance with cervico-vaginal cytology and col poscopic examination. The rate of residual lesions (cervical intra-epitheli al neoplasia: CIN 3) after conization with positive margin was 14.5% (n = 8 ). Conclusion: Residual persistent dysplasia is not present in all patients af ter conization with positive margins. Cytology and colposcopy allow detecti on of dysplasia, indicating the need for a second conization. In women with no desire for further pregnancy, systematic repeat surgery must be recomme nded. (C) 2000 Editions scientifiques et medicales Elsevier SAS.