Predictors of residual carcinoma or carcinoma-in-situ at hysterectomy following cervical conization with positive margins

Elena S. Diaz, Chisa Aoyama, Mary Anne Baquing, Anna Beavis, Elvio Silva, Christine Holschneider, Ilana Cass

Research output: Contribution to journalArticle

Abstract

Objectives Identify predictors of residual carcinoma or carcinoma-in-situ (CIS) at hysterectomy following cervical conizations with CIS and positive margins or endocervical curettage (ECC) or microinvasive cervical cancer. Methods Patients with cervical conization with CIS and positive margins, ECC or microinvasive carcinoma who underwent hysterectomy within 6 months of conization were identified. Conization and hysterectomy specimens were re-reviewed to assess volume of disease, ECC and margin status and residual carcinoma. Standard statistical tests were used. Results 83 patients were included. 34 (41%) had residual carcinoma in the hysterectomy specimen: 23 CIS, 9 microinvasive and 2 invasive disease. In patients with squamous histology predictors of residual disease included a positive ECC (p = 0.04), combined endocervical margin and ECC (69% if both positive, 38% either positive, 11% if both negative, p = 0.01) and volume of disease ≥ 50% (p = 0.01). In patients with glandular histology no factor predicted residual disease. Type of conization, > 2 involved quadrants, and the presence of microinvasion in the conization specimen did not predict residual disease. No patient with squamous histology had > Stage IA1 disease at hysterectomy, whereas 2 (2.4%) with adenocarcinoma had > Stage IA1 disease at hysterectomy. Conclusions Residual carcinoma or CIS is present in nearly half of hysterectomies after conization with CIS and positive ECC, margins or microinvasion. Patients with squamous histology may not require repeat conization prior to definitive therapy. No factors predict residual disease with adenocarcinoma. In women with AIS with negative margins and ECC and no microinvasion, it appears reasonable to proceed with simple hysterectomy.

Original languageEnglish (US)
Pages (from-to)76-80
Number of pages5
JournalGynecologic oncology
Volume132
Issue number1
DOIs
StatePublished - Jan 1 2014

Keywords

  • Cervical carcinoma in-situ
  • Microinvasive cervical cancer
  • Positive endocervical curettage
  • Positive margins
  • Residual disease

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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