Cervical intraepithelial neoplasia III: long-term outcome after cold-knife conization with clear margins.
OBJECTIVE
To evaluate the long-term outcome of patients with severe cervical intraepithelial neoplasia or squamous cell carcinoma in situ (CIN III) after cold-knife conization with clear margins.


METHODS
A total of 4417 women (mean age 36, range 18-72 years) with histologically confirmed CIN III had cold-knife conization with clear margins at our institution between 1970 and 1994. All patients were followed up with colposcopy, cytology, and pelvic examination for a mean of 18 years (range 5-30years).


RESULTS
New high-grade squamous intraepithelial lesions (SILs) (CIN II and III) developed in 15 (0.35%) patients (mean age 35, range 25-65 years) after a median of 107 (range 40-201) months. A total of 4402 (99.65%) patients (mean age 36, range 18-72 years) were free of high-grade SILs after a mean follow-up of 18 (range 5-30) years. High-grade glandular intraepithelial lesions developed in two (0.05%) patients 14 and 17 years after conization. Twelve (0.3%) patients had metachronous vulvar intraepithelial neoplasia (VIN) grade III or vaginal intraepithelial neoplasia (VAIN) grade III, and one (0.02%) patient had invasive vaginal carcinoma 10 years after conization.


CONCLUSIONS
Cold-knife conization with clear margins was an adequate method to definitively treat CIN III.
Department of Obstetrics and Gynecology, University of Graz, Graz, Austria. olaf.reich@kfunigraz.ac.at
O
O
Reich
H
H
Pickel
M
M
Lahousen
K
K
Tamussino
R
R
Winter
D000293:Adolescent; D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D002278:Carcinoma in Situ / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D019092:Conization / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008499:Medical Records; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000401:mortality* / Q000473:pathology / Q000601:surgery