Objective: This study was performed to evaluate the significance of positive resection margins (RMs) of electrosurgical conization with cold coagulation as definitive treatments for patients with cervical intraepithelial neoplasia (CIN).
Methods: We retrospectively reviewed 306 patients who underwent electrosurgical conization with cold coagulation for CIN treatment at our institute from August 2005 to December 2016. A right-angled triangular loop in a single pass followed by a cold coagulator (120°C) to the cone bed for 10 to 20 seconds was used. Patients with positive RMs were underwent pap smear, human papilloma virus (HPV) DNA testing, and endocervical curettage after 3-6 months without additional treatments. Patients with margin positive invasive carcinoma or adenocarcinoma in situ (AIS) recommended hysterectomy, firstly. Pathologic reports and clinical data were obtained and evaluated.
Results: Histopathological evaluation of electrosurgical conization materials revealed the presence of CIN I in 54, CIN II/III in 241, AIS in 3, and invasive carcinoma in 8 (microinvasive/adenocarcinoma, 7/1, respectively) patients. Margins were positive in 41 (13.4%) cases; 0 in CIN I, 37 in CIN II/III (15.4%), 1 in AIS (33.3%), and 3 in invasive carcinoma (37.5%), respectively. Twenty-eight patients had positive endocervical RMs, while thirteen patients had positive exocervical RMs. In this series, there were no cases with simultaneous positive endocervical and exocervical RMs . Six patients with positive margins were lost to follow-up. Two CIN cases with positive RMs revealed 1 CIN I and 1 CIN III at first follow-up. Three microinvasive carcinoma cases revealed 1 no residual disease, 1 CIN I, and 1 CIN II after hysterectomy. However, one adenocarcinoma case without positive RM and one AIS case with positive RM revealed no residual disease after hysterectomy. Totally, four out of 300 patients (1.3%) who underwent electrosurgical conization with cold coagulation had residual diseases.
Conclusions: These results suggest that electrosurgical conization with cold coagulation is
a feasible treatment for CIN cases with a low risk of residual disease. Patients who are diagnosed with CIN preoperatively could be followed up without additional treatments in spite of positive RMs.
Key Words: Cervical intraepithelial neoplasia, Microinvasive carcinoma, Electrosurgical conization, Cold coagulation, Resection margin