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Positive pathological margins after loop electrosurgical excision procedure - Management and outcome
Sharon Davidesko1, Mihai Meirovitz1, Ruthy Shaco-Levy2
1Department 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.
Summary
Management of positive cervical conization margins is controversial. Surveillance is a safe alternative to additional surgery, with similar recurrence rates, especially for younger women.
Area of Science:
- Gynecology
- Oncology
- Surgical Pathology
Background:
- Positive margins after cervical conization are a known risk factor for recurrence.
- Current management strategies for positive margins are debated, impacting patient outcomes.
Purpose of the Study:
- To identify risk factors associated with positive margins following cervical conization.
- To compare recurrence rates between conservative management (surveillance) and additional surgical intervention for positive margins.
Main Methods:
- Retrospective analysis of 448 cervical conizations (2010-2019).
- Univariate analysis to determine factors linked to positive margins.
- Comparison of recurrence rates across surveillance, repeat conization, and hysterectomy groups using Kaplan-Meier curves.
Main Results:
- 29.2% of conizations had positive margins, associated with menopause, high-grade cytology, and endocervical gland involvement.
- Recurrence rates did not significantly differ between surveillance (6.4%) and additional surgery (7.1%) groups (p=0.869).
- Residual disease was found in over 50% of hysterectomy and repeat conization specimens.
Conclusions:
- Surveillance is non-inferior to additional surgery for managing positive cervical conization margins.
- Conservative management is a valid option, particularly for younger women and those at risk of surgical complications.
