Giray Burak, Kabaca-Kocakusak Canan, Guray-Uzun Mine, Akis Serkan
Department of Gynecologic Oncology, Zeynep Kamil Women's and Children's Disease Training and Research Hospital, Istanbul, Turkey.
J Obstet Gynaecol. 2020 Apr;40(3):406-410. doi: 10.1080/01443615.2019.1633517. Epub 2019 Aug 28.
The aim of this study was to investigate whether patients with CIN 2/3 with different amount of distance to negative cone biopsy margin differ in terms of post-conization follow-up results. Cold-knife cone specimens with a negative surgical margin with a diagnosis of CIN-2/3 were selected. The minimum distance between the margin and lesion was categorised as less than 2 mm (Group-1), 2-5 mm (Group-2), or more than 5 mm (Group-3). There were no statistically significant differences between groups in terms of postoperative cone-biopsy results ( = .61). Furthermore, there were no statistically significant differences between groups in terms of cytology at 6 months and 12 months ( = .33 and = .80, respectively). Results of the present study indicate that the amount of distance of lesion to cone biopsy margin seems to have no effect on follow-up results in patients with negative surgical margin.Impact Statement Negative surgical margins on conization are associated with lower rates of lesion recurrence. Only the efficacy of volume and size of cone biopsy specimens have been analysed on lesion recurrence. However, there is no clear definition of the minimum distance of a negative margin during cone biopsy. To the best of our knowledge, this is the first study describing the post-conization follow-up of patients with CIN 2/3 with different amount of distance to negative cone biopsy margin. Patients who underwent surgical treatment with a wider cone biopsy margin and narrower cone biopsy margin demonstrated similar follow-up results. The present study provides valuable information to guide physicians performing conizations with an appropriate amount of negative surgical margin. Future studies investigating the effect of different amount of distance to negative cone biopsy margin on gynaecologic and obstetrics complications such as stenosis, bleeding, and preterm labour, low birth weight, and perinatal mortality are needed to show the benefits of a narrower distance to negative cone biopsy margin.
本研究的目的是调查锥切边缘阴性距离不同的CIN 2/3患者在锥切术后随访结果方面是否存在差异。选取手术切缘阴性且诊断为CIN-2/3的冷刀锥切标本。将切缘与病变之间的最小距离分为小于2毫米（第1组）、2 - 5毫米（第2组）或大于5毫米（第3组）。各组术后锥切活检结果之间无统计学显著差异（P = 0.61）。此外，各组在6个月和12个月时的细胞学检查结果也无统计学显著差异（分别为P = 0.33和P = 0.80）。本研究结果表明，病变至锥切活检边缘的距离似乎对手术切缘阴性患者的随访结果没有影响。影响声明锥切手术切缘阴性与病变复发率较低相关。仅分析了锥切活检标本的体积和大小对病变复发的影响。然而，锥切活检时阴性切缘的最小距离尚无明确界定。据我们所知，这是第一项描述锥切边缘阴性距离不同的CIN 2/3患者锥切术后随访情况的研究。接受较宽锥切活检边缘和较窄锥切活检边缘手术治疗的患者显示出相似的随访结果。本研究为指导医生进行具有适当阴性手术切缘的锥切手术提供了有价值的信息。未来需要开展研究，调查锥切边缘阴性距离不同对妇产科并发症（如狭窄、出血、早产、低出生体重和围产期死亡率）的影响，以显示更窄的锥切边缘阴性距离的益处。
