Management of patients with positive margins after cervical conization.

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.