Ritu Salani1, Isha Puri, Robert E Bristow. 1. Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Ohio State Medical Center, Columbus, OH 43210, USA. rsalani1@jhmi.edu
Abstract
OBJECTIVE: We sought to determine the value of conization margin status in predicting residual and recurrent adenocarcinoma in situ (ACIS) of the cervix. STUDY DESIGN: In all, 33 studies (1278 patients) were identified. Metaanalysis with pooled Mantel-Haenszel odds ratio (OR) was used to compare the risk of residual and recurrent disease according to margin status. RESULTS: A repeated excisional procedure was performed in 607 patients; a positive conization margin was associated with a significant increase in the risk of residual disease (OR, 4.01; 95% confidence interval [CI], 2.62-6.33; P < .001). Of the 671 patients followed up with surveillance only, 2.6% with negative margins and 19.4% with positive margins developed a recurrence (OR, 2.48; 95% CI, 1.05-6.22; P < .001). Invasive adenocarcinoma was more commonly associated with positive margins (5.2%) compared with negative margins (0.1%). CONCLUSION: After conization for ACIS, patients with positive margins are significantly more likely to have residual or recurrent disease, whereas those with negative margins may be treated conservatively.
OBJECTIVE: We sought to determine the value of conization margin status in predicting residual and recurrent adenocarcinoma in situ (ACIS) of the cervix. STUDY DESIGN: In all, 33 studies (1278 patients) were identified. Metaanalysis with pooled Mantel-Haenszel odds ratio (OR) was used to compare the risk of residual and recurrent disease according to margin status. RESULTS: A repeated excisional procedure was performed in 607 patients; a positive conization margin was associated with a significant increase in the risk of residual disease (OR, 4.01; 95% confidence interval [CI], 2.62-6.33; P < .001). Of the 671 patients followed up with surveillance only, 2.6% with negative margins and 19.4% with positive margins developed a recurrence (OR, 2.48; 95% CI, 1.05-6.22; P < .001). Invasive adenocarcinoma was more commonly associated with positive margins (5.2%) compared with negative margins (0.1%). CONCLUSION: After conization for ACIS, patients with positive margins are significantly more likely to have residual or recurrent disease, whereas those with negative margins may be treated conservatively.
Authors: Anthony B Costales; Andrea M Milbourne; Helen E Rhodes; Mark F Munsell; John J Wallbillich; Jubilee Brown; Michael Frumovitz; Lois M Ramondetta; Kathleen M Schmeler Journal: Gynecol Oncol Date: 2013-03-28 Impact factor: 5.482
Authors: Ramez N Eskander; Leslie M Randall; Michael L Berman; Krishnansu S Tewari; Philip J Disaia; Robert E Bristow Journal: Am J Obstet Gynecol Date: 2011-03-16 Impact factor: 8.661
Authors: Anthony B Costales; Patricia J Eifel; Michael T Deavers; Michael Frumovitz; Kathleen M Schmeler Journal: Gynecol Oncol Case Rep Date: 2012-05-09