Cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma

To examine the association between cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma.

Fifty-four patients diagnosed by cone biopsy with stage I cervical carcinoma and treated with radical hysterectomy comprised the study group. The association between the depth of invasion on conization, lymph-vascular invasion, positive cone margins, positive endocervical curettage (ECC), and the depth of residual invasion in the radical hysterectomy specimen was examined using Pearson r and point biserial correlation. Independent predictors of the depth of residual invasion were determined by multiple regression.

The depth of residual invasion correlated significantly with the depth of invasion (r =.374) and presence of lymph-vascular invasion (r(pb)=.372) in the conization specimen, post-cone ECC status (r(pb) =.669), and age at diagnosis (r =.347). The same factors were jointly assessed using multiple regression (R(2) =.636, P<.001). Depth of invasion on conization, lymph-vascular invasion, and ECC status were identified as independent predictors of the depth of residual invasion. Patients with deep (5 mm or greater) stromal invasion and lymph-vascular invasion on conization had significantly higher rates of positive parametrial margins (22% compared with zero, P =.001) and adjuvant radiation (66.7% compared with 20%, P =.004) compared with all other patients.

Depth of invasion, presence of lymph-vascular invasion, and age at diagnosis were independent predictors of the depth of residual invasion in the subsequent hysterectomy specimen. These factors should be considered in treatment planning. Patients with a combination of these factors may have increased risk for deep residual invasion, positive hysterectomy margins, and adjuvant radiation.