Alvarado CI, Pilar CD, Valencia CR, Quijano CF

Language: Spanish
References: 20
Page: 272-276
PDF size: 210.81 Kb.

ABSTRACT

The optimal management of cervical intraepithelial neoplasia (CIN) after conization remains controversial. Reliable predictors of residual disease (RD) in the hysterectomy after conization have not been consistently identified. This study was done to determine factors predicting post-cone RD in CIN II/III.
Methods. From January 1998 to December 2008, 92 patients with CIN II/III who received hysterectomy within 6-12 months of conization regardless of marginal status were identified from 255 conization cases. Clinical features and pathologic parameters were analyzed for the predictive rate of post-cone RD.
Results. Age ≥ 52 years and parity ≥ 4 were significant factor associated with RD. The incidence of RD was 58 vs 32% in patients ≥ 52 years vs ‹ 52 years respectively, and 51.5 vs 34% in patients with parity ≥ 4 or ‹ 4, respectively. Dysplasia involving endocervical margin (EM), positive endocervical curettage (ECC) and ≥ 3 quadrant with disease were the only pathologic predictive factors identified. The incidence of RD was 51 and 39% in patients with positive vs negative EM, respectively and 66 and 32% in patients with positive ECC respectively. Other pathologic parameters including ectocervical margins, endocervical gland involvement and type of conization (cold knife vs LEEP procedure) were not predictor of RD.
Conclusions. Increasing age (≥ 52 years) and parity (≥ 4), positive EM and ECC and multiple-quadrant disease were the only significant factors predicting post-cone RD. Appropiate application of these predictive factors may avoid post-cone hysterectomy.

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