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Korean Journal of Obstetrics & Gynecology 2008;51(11):1295-1301.
Published online November 1, 2008.
Analysis of residual tumor based on pathologic severity and site of positive margin after cold-knife conization of the uterine cervix.
Eun Suk Lee, Dae Hoon Jeong, Jeong Mi Byun, Jong Hyuk Kim, Eun Jeong Jeong, Doo Young Chang, Chul Hoi Jeong, Kyung Bok Lee, Moon Su Sung, Ki Tae Kim
1Department of Obstetrics and Gynecology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea. obgynjeong@hanmail.net
2Paik Institute for Clinical Research, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea.
3Department of Obstetrics and Gynecology, Ilsan Paik Hospital, College of Medicine, Inje University, Gyeonggi, Korea.
4Department of Obstetrics and Gynecology, Dongrae Paik Hospital, College of Medicine, Inje University, Busan, Korea.
Abstract
OBJECTIVE
To evaluate correlation of sites of positive margin and residual tumor and to establish management after conization. METHODS: Of 599 cold-knife conizations [15 (2.6%) with cervical intraepithelial neoplasia (CIN) I, 37 (6.1%) with CIN II, 450 (75.1%) with CIN III, 97 (16.2%) with microinvasion] performed at our institution from January, 1993 to June, 2006, 144 patients (24.0%) had positive margins and 113 patients were included in the retrospective study excluding 31 cases that were not followed more than 12 months. Correlation of conization pathology and residual tumor according to sites of positive margin were evaluated. RESULTS: The prevalence rates of positive margins were 6.7% (1/15) in CIN I, 21.6% (8/37) in CIN II, 21.1% (95/450) in CIN III, and 41.2% (40/97) in microinvasion. The prevalence rate of positive margin increased with severity of conization pathology (P=0.0001). Of 113 patients followed more than 12 months, 27.4% (31/113) had residual tumor [0.0% (0/1) in CIN I, 12.5% (1/8) in CIN II, 18.9% (14/74) in CIN III, and 53.3% (16/30) in microinvasion]. The prevalence rate of residual tumor increased with severity of conization pathology (P=0.0028). Residual tumor was more common in patients in whom both endocervical and exocervical margins or in whom only the endocervical margin were involved than in those in whom only exocervical margin was involved [87.5% (7/8) or 35.3% (24/68) versus 0% (0/37), respectively]. CONCLUSIONS: Expectant management is reasonable for patients with positive margin after conization. However, careful follow-up of these patients is essential, particularly in endocervical involvement.
Key Words: Cervical intraepithelial neoplasia, Conization, Positive margin, Residual tumor


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