title: Absence or Presence of High-Grade Squamous Intraepithelial Lesion in Cervical Conization Specimens: A Clinicopathologic Study of 540 Cases.
abstract: OBJECTIVE
  To explore the implications of cervical conization specimens lacking the targeted high-grade squamous intraepithelial lesions (negative cone).
  
  
  METHODS
  We studied 540 conization procedures: 400 positive cones and 140 negative cones. Clinicopathologic features and 2-year follow-up results were reported.
  
  
  RESULTS
  Negative cones comprised 22% of procedures triggered by CIN2 or higher biopsies. Procedures triggered by cytology produced much higher percentages of negative cones (37% high-grade squamous intraepithelial lesion [HSIL], 46% atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion [ASC-H], and 76% low-grade squamous intraepithelial lesion-cannot exclude high-grade squamous intraepithelial lesion [LSIL-H]). Upon reviewing negative excision-triggering biopsy and cytology, we downgraded 24 (24%) CIN2 biopsies, three (14%) HSIL, five (83%) ASC-H, and 12 (92%) LSIL-H. One-third of our negative cones can be attributed to overdiagnosis either on biopsy or cytology. Patients with negative cones were older and had smaller excisions, negative colposcopic findings, and negative/equivocal high-risk human papillomavirus (HR-HPV). Within 2 years, 35 (25%) women with negative cones experienced ASCUS or LSIL. Only one (0.7%) recurred as CIN3, a significantly lower percentage than women with positive cones (13%).
  
  
  CONCLUSIONS
  We advocate careful review of all excision-triggering biopsy and cytology, especially in cases of LSIL-H. Patients with negative cones should be surveyed with cytology and HR-HPV testing.
authors.affiliation: From the Departments of Pathology.
authors.forename: Vighnesh
authors.initials: V
authors.lastname: Walavalkar
authors.affiliation: From the Departments of Pathology.
authors.forename: Thomas
authors.initials: T
authors.lastname: Stockl
authors.affiliation: From the Departments of Pathology.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Owens
authors.affiliation: Obstetrics & Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester.
authors.forename: Mark
authors.initials: M
authors.lastname: Manning
authors.affiliation: Obstetrics & Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester.
authors.forename: Debra
authors.initials: D
authors.lastname: Papa
authors.affiliation: Obstetrics & Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester.
authors.forename: Anjie
authors.initials: A
authors.lastname: Li
authors.affiliation: From the Departments of Pathology.
authors.forename: Ashraf
authors.initials: A
authors.lastname: Khan
authors.affiliation: From the Departments of Pathology Yuxin.Liu@umassmemorial.org.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology*; D019092:Conization; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000473:pathology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology*
keywords: Cervical conization; HPV; High-grade squamous intraepithelial lesion; LEEP