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Predicting persistent/recurrent disease in the cervix after excisional biopsy
Sanjay M Ramchandani1, Karen L Houck, Enrique Hernandez
1Department of Obstetrics, Gynecology and Reproductive Sciences, Temple University Hospital, USA.
Medgenmed : Medscape General Medicine
|October 24, 2007
Summary
For persistent cervical disease after excisional biopsy, endocervical margin status and disease severity are key predictors. Endocervical curettage (ECC) does not add significant predictive value, suggesting it may not be routinely necessary.
Area of Science:
- Gynecology
- Oncology
- Pathology
Background:
- Cervical cancer screening and treatment often involve excisional procedures like cold knife conization or loop electrosurgical excision (LEEP).
- Predicting persistent or recurrent cervical disease after these procedures is crucial for patient management.
- The role of endocervical curettage (ECC) in conjunction with excisional biopsy in predicting disease recurrence requires further clarification.
Purpose of the Study:
- To assess the predictive capability of various factors, including endocervical curettage (ECC), for persistent or recurrent disease following excisional biopsy of the cervical transformation zone.
- To determine if ECC provides additional predictive value beyond other histopathological findings and margin status.
Main Methods:
- A retrospective chart review of 152 women who underwent excisional biopsy (conization or LEEP) with concurrent ECC.
- Analysis of patient age, histopathology of the conization specimen, ectocervical margin, endocervical margin, and ECC findings.
- Statistical analysis, including multivariate logistic regression, to identify predictors of subsequent disease.
Main Results:
- Positive endocervical margin, positive ectocervical margin, positive ECC specimens, and disease severity were individually associated with persistent/recurrent disease.
- In multivariate analysis, endocervical margin status and disease severity were significant predictors.
- ECC results did not add incremental predictive value when adjusted for endocervical margin status and disease severity.
Conclusions:
- Endocervical margin status and severity of cervical disease are significant predictors of persistent/recurrent disease after excisional biopsy.
- Endocervical curettage (ECC) does not appear to offer additional predictive value in this context.
- Routine performance of ECC at the time of excisional biopsy of the cervical transformation zone may not be necessary.