Katerina Papakonstantinou1, Maria Kyrgiou2, Deidre Lyons3, William P Soutter4, Sadaf Ghaem-Maghami5. 1. West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK. 2. West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, England, UK. Electronic address: m.kyrgiou@imperial.ac.uk. 3. Department of Obstetrics and Gynaecology, St Mary's Hospital, Imperial Healthcare NHS Trust, London, England, UK. 4. Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, England, UK. 5. West London Gynaecological Cancer Centre, Queen Charlotte's and Chelsea-Hammersmith Hospital, Imperial Healthcare NHS Trust, London, England, UK; Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, England, UK.
Abstract
OBJECTIVE: The aim of this study was to assess the effect of the excision margin after cone for stage Ia1 cervical cancer on long-term outcomes. STUDY DESIGN: Retrospective observational study. Patients were divided into 3 groups. Group A underwent immediate reflex hysterectomy; group B had cervical intraepithelial neoplasia (CIN) at the margins but were followed up; group C had clear margins. RESULTS: We identified 111 women: 19 (17.1%) in group A; 29 (26.1%) in group B; and 63 (56.8%) in group C. Women in group A were older (median, 40 years vs 35 years; P = .0001) with higher rate of endocervical margin involvement (89.5 vs 48.1%, P = .007) than in group B. The women had been followed for a total of 960 woman-years with median follow-up of 398 weeks (quartiles: 258,612). Women with clear margins in the initial excision were more likely to remain free of disease than those with involved (P < .0001). Further surgery was required due to abnormal cytology in 9 (31.0%) women from group B and 7 (11.1%) from group C (P = .04). The cumulative rate of recurrent CIN2+ was 6.4% in group B and 2.7% in group C (P = .17). In group B, recurrences were more common in positive endocervical rather than ectocervical margins (66.6% vs 33.4%, P < .05); all had high-grade CIN at the margins. CONCLUSION: The risk of posttreatment CIN2+ is substantially reduced when complete excision is achieved at first treatment. Conservative management is contraindicated in women with microinvasion at the margin. When CIN involves the margin, there is a greater risk of residual disease and of further treatment.
OBJECTIVE: The aim of this study was to assess the effect of the excision margin after cone for stage Ia1 cervical cancer on long-term outcomes. STUDY DESIGN: Retrospective observational study. Patients were divided into 3 groups. Group A underwent immediate reflex hysterectomy; group B had cervical intraepithelial neoplasia (CIN) at the margins but were followed up; group C had clear margins. RESULTS: We identified 111 women: 19 (17.1%) in group A; 29 (26.1%) in group B; and 63 (56.8%) in group C. Women in group A were older (median, 40 years vs 35 years; P = .0001) with higher rate of endocervical margin involvement (89.5 vs 48.1%, P = .007) than in group B. The women had been followed for a total of 960 woman-years with median follow-up of 398 weeks (quartiles: 258,612). Women with clear margins in the initial excision were more likely to remain free of disease than those with involved (P < .0001). Further surgery was required due to abnormal cytology in 9 (31.0%) women from group B and 7 (11.1%) from group C (P = .04). The cumulative rate of recurrent CIN2+ was 6.4% in group B and 2.7% in group C (P = .17). In group B, recurrences were more common in positive endocervical rather than ectocervical margins (66.6% vs 33.4%, P < .05); all had high-grade CIN at the margins. CONCLUSION: The risk of posttreatment CIN2+ is substantially reduced when complete excision is achieved at first treatment. Conservative management is contraindicated in women with microinvasion at the margin. When CIN involves the margin, there is a greater risk of residual disease and of further treatment.
Authors: Annarosa Del Mistro; Mario Matteucci; Egle Alba Insacco; GianLibero Onnis; Filippo Da Re; Lorena Baboci; Manuel Zorzi; Daria Minucci Journal: Biomed Res Int Date: 2015-06-09 Impact factor: 3.411
Authors: Caio A Hartman; Joana F Bragança; Maria Salete C Gurgel; Luiz C Zeferino; Liliana A L A Andrade; Julio C Teixeira Journal: PLoS One Date: 2021-07-20 Impact factor: 3.240