Positive pathological margins after loop electrosurgical excision procedure - Management and outcome

Sharon Davidesko; Mihai Meirovitz; Ruthy Shaco-Levy; Tamar Wainstock; Yael Baumfeld; Miriam Erenberg; Shanny Sade; Roy Kessous

doi:10.1016/j.ejso.2023.01.025

Positive pathological margins after loop electrosurgical excision procedure - Management and outcome

Eur J Surg Oncol. 2023 May;49(5):1031-1036. doi: 10.1016/j.ejso.2023.01.025. Epub 2023 Jan 26.

Authors

Sharon Davidesko¹, Mihai Meirovitz², Ruthy Shaco-Levy³, Tamar Wainstock⁴, Yael Baumfeld⁵, Miriam Erenberg⁵, Shanny Sade⁵, Roy Kessous⁶

Affiliations

¹ Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel. Electronic address: shazadmoni85@gmail.com.
² Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
³ Department of Pathology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
⁴ Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel.
⁵ Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
⁶ Department of Gynecological Oncology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.

PMID: 36737281
DOI: 10.1016/j.ejso.2023.01.025

Abstract

Objective: Pathological involvement of cervical conization margins is a risk factor for recurrence, although management of these patients is controversial. We aimed to define risk factors for positive margins and compare recurrence following additional surgical intervention compared to conservative management.

Methods: A retrospective study of all conizations at our center between 2010 and 2019. Univariate analysis identified characteristics associated with positive margins. Women were stratified by mode of management comparing three groups (surveillance, repeat conization or hysterectomy) then two groups (surveillance vs. additional surgery). Kaplan Meyer survival curves compared cumulative recurrence stratified by mode of management. Pathological results of subsequent surgical procedures were examined for residual disease.

Results: Of 448 conizations performed, 131 (29.2%) had positive margins which were associated with menopause, high-grade cytology and endocervical gland involvement. Women who underwent surveillance (n = 45) were more likely to be nulliparous, with low-grade histology and less endocervical gland involvement. Women who underwent hysterectomy (n = 61) were more likely to be postmenopausal and parous. Recurrence did not differ significantly in the three-group (p = 0.073) or two-group model (6.4% vs. 7.1% p = 0.869). Kaplan Meyer survival curves depicting cumulative recurrence did not differ significantly in either model (log rank test p = 0.642 for the three-group model, and p = 0.868 for the two-group model). Residual disease was found in 51.6% of hysterectomy specimens and 52.6% of repeat conizations.

Conclusion: Surveillance is non-inferior to additional surgery in cases with positive conization margins and constitutes a valid option specifically for younger women at risk of future obstetric complications and those susceptible post-hysterectomy complications.

Keywords: Cervical intra-epithelial neoplasia; Conization; Positive margins; Recurrence; Risk factors.

MeSH terms

Conization / methods
Electrosurgery
Female
Humans
Margins of Excision
Neoplasm Recurrence, Local / epidemiology
Neoplasm Recurrence, Local / surgery
Neoplasm, Residual / pathology
Pregnancy
Retrospective Studies
Uterine Cervical Dysplasia* / pathology
Uterine Cervical Neoplasms* / pathology
Uterine Cervical Neoplasms* / surgery