title: Disease persistence in patients with cervical intraepithelial neoplasia undergoing electrosurgical conization.
abstract: OBJECTIVE
  Cone margin status has been reported to be the most important predictor of residual disease in patients with cervical intraepithelial neoplasia (CIN) undergoing electrosurgical excisional treatment. The primary aim of this study of patients treated with electrosurgical conization was to evaluate the association of cone margin status and other clinical and pathologic factors with the probability of residual disease.
  
  
  METHODS
  The study population comprised 699 patients with at least one follow-up visit within 12 months of conization. Residual disease was defined as a histology diagnosis of CIN within 3 years of conization. Multivariate associations were evaluated with multiple logistic regression analysis.
  
  
  RESULTS
  Attendance to follow-up was 97% for the second visit and 34% for the third visit. Residual disease was detected in a total of 38 patients (5.4%). The detection rate was 3.3% at the first visit, 2.1% at the second visit, and 0.4% at the third visit. An increased probability of residual disease was associated with a referral Pap smear reported as high-grade squamous intraepithelial neoplasia and carcinoma (odds ratio, 2.9; reference category, low-grade squamous intraepithelial neoplasia). A decreased probability was associated with a squamocolumnar junction entirely visible at the first follow-up visit (odds ratio, 0.2; reference category, squamocolumnar junction not visible). Patient age, time period, lesion size, lesion site, grade of CIN, cone width, cone depth, and margin status had no influence.
  
  
  CONCLUSIONS
  The determinants of residual disease in this study differed from those generally reported so far. Factors associated with effectiveness of electrosurgical treatment of CIN need further research.
authors.affiliation: Department of Obstetrics and Gynecology, University of Bologna, Bologna.
authors.forename: Silvano
authors.initials: S
authors.lastname: Costa
authors.forename: Maria
authors.initials: M
authors.lastname: De Nuzzo
authors.forename: Fanny E
authors.initials: FE
authors.lastname: Infante
authors.forename: Benedetta
authors.initials: B
authors.lastname: Bonavita
authors.forename: Marica
authors.initials: M
authors.lastname: Marinelli
authors.forename: Anna
authors.initials: A
authors.lastname: Rubino
authors.forename: Valeria
authors.initials: V
authors.lastname: Rambelli
authors.forename: Donatella
authors.initials: D
authors.lastname: Santini
authors.forename: Paolo
authors.initials: P
authors.lastname: Cristiani
authors.forename: Lauro
authors.initials: L
authors.lastname: Bucchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019092:Conization / Q000379:methods*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D018365:Neoplasm, Residual; D065006:Papanicolaou Test; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*