The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia.
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.
Bretelle
Florence
F
Department of Obstetrics and Gynaecology, Conception Hospital, Marseille, France.
Agostini
Aubert
A
Rojat-Habib
Marie Christine
MC
Cravello
Ludovic
L
Roger
Valérie
V
Blanc
Bernard
B
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