title: Predictors of residual carcinoma or carcinoma-in-situ at hysterectomy following cervical conization with positive margins.
abstract: OBJECTIVE
  Identify predictors of residual carcinoma or carcinoma-in-situ (CIS) at hysterectomy following cervical conizations with CIS and positive margins or endocervical curettage (ECC) or microinvasive cervical cancer.
  
  
  METHODS
  Patients with cervical conization with CIS and positive margins, ECC or microinvasive carcinoma who underwent hysterectomy within 6 months of conization were identified. Conization and hysterectomy specimens were re-reviewed to assess volume of disease, ECC and margin status and residual carcinoma. Standard statistical tests were used.
  
  
  RESULTS
  83 patients were included. 34 (41%) had residual carcinoma in the hysterectomy specimen: 23 CIS, 9 microinvasive and 2 invasive disease. In patients with squamous histology predictors of residual disease included a positive ECC (p=0.04), combined endocervical margin and ECC (69% if both positive, 38% either positive, 11% if both negative, p=0.01) and volume of disease ≥ 50% (p=0.01). In patients with glandular histology no factor predicted residual disease. Type of conization, >2 involved quadrants, and the presence of microinvasion in the conization specimen did not predict residual disease. No patient with squamous histology had >Stage IA1 disease at hysterectomy, whereas 2 (2.4%) with adenocarcinoma had >Stage IA1 disease at hysterectomy.
  
  
  CONCLUSIONS
  Residual carcinoma or CIS is present in nearly half of hysterectomies after conization with CIS and positive ECC, margins or microinvasion. Patients with squamous histology may not require repeat conization prior to definitive therapy. No factors predict residual disease with adenocarcinoma. In women with AIS with negative margins and ECC and no microinvasion, it appears reasonable to proceed with simple hysterectomy.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, NorthShore University Health System, Evanston, IL, USA.
authors.forename: Elena S
authors.initials: ES
authors.lastname: Diaz
authors.affiliation: Department of Pathology and Laboratory Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA.
authors.forename: Chisa
authors.initials: C
authors.lastname: Aoyama
authors.affiliation: Department of Obstetrics and Gynecology, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Baquing
authors.affiliation: Department of Obstetrics and Gynecology, Olive View-UCLA Medical Center, Sylmar, CA, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Beavis
authors.affiliation: Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
authors.forename: Elvio
authors.initials: E
authors.lastname: Silva
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Olive View-UCLA Medical Center, Sylmar, CA, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Holschneider
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, 8635 West 3rd Street, Suite 280W, Los Angeles, CA 90048, USA.
authors.forename: Ilana
authors.initials: I
authors.lastname: Cass
mesh_terms: D000328:Adult; D000368:Aged; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000601:surgery*; D019092:Conization; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cervical carcinoma in-situ; Microinvasive cervical cancer; Positive endocervical curettage; Positive margins; Residual disease