Cervical intraepithelial neoplasia after conization: a study of 522 consecutive cervical cones

The relationship between involvement of the cervical cone margins by cervical intraepithelial neoplasia (CIN) and the presence or absence of CIN as determined by subsequent hysterectomy or cytology follow-up was studied in 522 cervical cones. Hysterectomy was performed in 161 patients, 54% of which were done within six weeks after conization. The remaining patients were followed up with cytology. In 136 women, cone margins were involved by CIN. Twelve of these patients were lost to follow-up. Forty of the 73 (54.8%) patients who underwent hysterectomy had CIN in the uterus. One of 51 (1.9%) patients followed up with cytology developed cytologic evidence of CIN. In 60% of the patients with CIN III and involved margins, in whom hysterectomy was delayed for more than six weeks, there was at least one interval of cytology positive for CIN. All these patients had CIN at the time of hysterectomy. In contrast, CIN was not present in patients with negative follow-up cytology. None of the 107 patients with CIN III and free margins had CIN at hysterectomy or during follow-up. However, of the 249 women with CIN I to II and free margins, six had CIN at hysterectomy. In none of the cases was the residual disease worse than CIN. Although it is impossible to predict the presence or absence of residual CIN based on the appearance of the cone margins, it is important to report the status of the margins. Free margins indicate removal of the CIN in a majority of cases, or reassures that invasive cancer is not present.(ABSTRACT TRUNCATED AT 250 WORDS)