Cervical intraepithelial neoplasia III: Long-term outcome after cold-knifeconization with clear margins

Objective: To evaluate the long-term outcome of patients with severe cervic al intraepithelial neoplasia or squamous cell carcinoma in situ (CIN III) a fter cold-knife conization with clear margins. Methods: A total of 4417 women (mean age 36, range 18-72 years) with histol ogically confirmed CIN III had cold-knife conization with clear margins at our institution between 1970 and 1994. All patients were followed up with c olposcopy, cytology, and pelvic examination for a mean of 18 years (range 5 -30 years). Results: New high-grade squamous intraepithelial lesions (SILs) (CIN II and III) developed in 15 (0.35%) patients (mean age 35, range 25-65 years) aft er a median of 107 (range 40-201) months. A total of 4402 (99.65%) patients (mean age 36, range 18-72 years) were free of high-grade SILs after a mean follow-up of 18 (range 5-30) years. High-grade glandular intraepithelial l esions developed in two (0.05%) patients 14 and 17 years after conization. Twelve (0.3%) patients had metachronous vulvar intraepithelial neoplasia (V IN) grade III or vaginal intraepithelial neoplasia (VAIN) grade III, and on e (0.02%) patient had invasive vaginal carcinoma 10 years after conization. Conclusion: Cold-knife conization with clear margins was an adequate method to definitively treat CIN III. (C) 2001 by The American College of Obstetr icians and Gynecologists.