title: The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia.
abstract: OBJECTIVE
  To determine whether frozen section in conisation improves the management of cervical intraepithelial neoplasia.
  
  
  METHODS
  Randomised trial.
  
  
  METHODS
  Department of Obstetrics and Gynaecology, Conception Hospital, Marseille, France.
  
  
  METHODS
  Patients referred for treatment or diagnosis of cervical intraepithelial neoplasia.
  
  
  METHODS
  Two hundred and three patients requiring conisation for diagnosis or treatment of cervical pathology were randomly assigned to have (n = 102) or not (n = 101) a frozen section of the endocervical margin of the cone specimen.
  
  
  METHODS
  The principal criterion was the 12 month residual or recurrent high grade disease rate.
  
  
  RESULTS
  At 12 months, the residual or recurrent disease rate of high grade lesions was 12.6% in the group that did not have frozen sections and 1% in the group that did (relative risk, RR, 11.9, 95% CI 1.6-89.5, P = 0.0025). The corresponding rates of margin involvement were 18.9% and 1%, respectively (RR 15.13, 95% CI 2.06-111.27, P = 0.0002). The groups did not differ as to the height of the cone (13.6 [5.6] mm vs 13.7 [4.7] mm, P = 0.75) or post-operative morbidity (6% vs 7%, RR 1.01, 95% CI 0.94-1.09, P = 0.8). The rate of patients lost to follow up was similar in both groups 17% vs 12% (RR 1.42, 95% CI 0.71-2.81, P = 0.31).
  
  
  CONCLUSIONS
  Frozen section is effective in conisation and significantly reduces residual or recurrent high grade disease. This finding improves the management of cervical pathology achieving immediate clear margins in most of conisations. This is of great interest because high rates of patients are lost to follow up as we and others authors have found.
authors.affiliation: Department of Obstetrics and Gynaecology, Conception Hospital, Marseille, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Bretelle
authors.forename: Aubert
authors.initials: A
authors.lastname: Agostini
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Rojat-Habib
authors.forename: Ludovic
authors.initials: L
authors.lastname: Cravello
authors.forename: Valérie
authors.initials: V
authors.lastname: Roger
authors.forename: Bernard
authors.initials: B
authors.lastname: Blanc
mesh_terms: D000328:Adult; D000465:Algorithms; D001706:Biopsy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005629:Frozen Sections; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012086:Reoperation; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery