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Management of patients with positive margins after cervical conization
T K Lapaquette1, T V Dinh, E V Hannigan
1Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston.
Objective:
To evaluate conservative management of patients undergoing cervical conization with cone margins positive for dysplasia.
Methods:
The outcomes of 93 patients with cone biopsies that had margins positive for dysplasia were tabulated.
Results:
Thirty of 47 patients (64%) undergoing conization only and followed by cytology had negative Papanicolaou smears for at least 2 years. Twenty-one of 37 women (57%) with conization and immediate hysterectomy had no residual disease in the cervix. Three of nine women (33%) with conization and delayed hysterectomy had no detectable dysplasia in the remaining cervix. There was no case of progression to invasive disease. The overall resolution rate was 58%. Persistence of disease was found most often at the endocervical margins associated with cervical intraepithelial neoplasia grade III.
Conclusion:
Patients with cone margins positive for dysplasia can be followed appropriately with cytology. In cases of recurrent abnormal Papanicolaou smears, colposcopy, biopsies, and endocervical curettage should be repeated.