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Federación Mexicana de Ginecología y Obstetricia, A.C.

2020, Number 09

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Ginecol Obstet Mex 2020; 88 (09)

Importance of surgical margins affected in cervical uterine conization

María-Ortiz JS, Álvarez-Silvares E, Bermúdez-González M, García LS, Pato MM, Couso CB

Language: Spanish
References: 76
Page: 586-597
PDF size: 266.22 Kb.


ABSTRACT

Objective: To determine the association between affected margins with persistencerecurrence of cervical intraepithelial neoplasia, persistence of human papillomavirus and re-interventions.
Materials and Methods: Study of cases and controls nested in a retrospective cohort of the Complexo Hospitalario Universitario de Ourense (January 2010-October 2017). Inclusion criteria: women with at least one post-intervention check-up. Exclusion criteria: women without evidence of high-grade dysplasia in the conization piece and who were not followed up. Study variables: age, smoking, condom, oral contraceptives, HPV vaccination, persistence-recurrence of CIN and HPV, and re-operation. Parametric and non-parametric tests were performed among the variables.
Results: The cohort consisted of 248 women, 81 of whom (32.6%) had affected surgical margins on conization. Immunosuppression, smoking and oral contraception were the most frequent associations in affected margins. Condom use and HPV vaccination were significantly more frequent in free margins. Affected margins reported greater persistence of HPV (50 vs 23.9%; OR 3.17 (1.90-5.26), p ‹ 0.001), persistent-recurrent disease (47.2 vs 22.5%; OR 3.07 (1.84-5.12), p ‹ 0.001), and reinterventions (40.2 vs 15.4%; OR 3.679 (2.094-6.463), p ‹ 0.028). The most affected margin was, in descending order, endocervical (55.6%), exocervical (25%) and both (19.4%).
Conclusions: The affected margin confers a significant risk in the evolution of HPV infection and disease recurrence.


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