Factors associated with positive margins in patients with cervical intraepithelial neoplasia grade 3 and postconization management

Int J Gynaecol Obstet. 2009 Nov;107(2):107-10. doi: 10.1016/j.ijgo.2009.05.027. Epub 2009 Jul 22.


Objective: To evaluate the risk factors for positive margins in cervical intraepithelial neoplasia (CIN) grade 3 and the outcomes of postconization management.

Methods: A retrospective review of the records of 1113 women who underwent conization for CIN 3 between 2000 and 2008.

Results: Positive margins occurred in the following: 104 (10.7%) women with severe dysplasia versus 37 (26.2%) with carcinoma in situ; 32 (4.8%) treated with cold knife conization versus 109 (24.1%) treated with the loop electrosurgical excision procedure (LEEP); and 124 (11.6%) premenopausal versus 17 (35.4%) postmenopausal women. None of the women with severe dysplasia had invasive disease in the repeat excision specimen, whereas 3 (8.6%) women with carcinoma in situ had residual microinvasive carcinoma.

Conclusion: LEEP, carcinoma in situ, menopausal status, and larger area of lesion are risk factors for positive margins. For women with CIN 3 and positive margins, follow-up at an interval of 6 months or repeat excision are treatment options. However, when repeat excision is technically impossible, whether simple hysterectomy or radical surgery is a rational treatment option requires further investigation.

MeSH terms

  • Adult
  • Aged
  • Conization / methods*
  • Electrosurgery / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Postmenopause
  • Postoperative Care / methods
  • Premenopause
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Uterine Cervical Dysplasia / pathology*
  • Uterine Cervical Dysplasia / surgery
  • Uterine Cervical Neoplasms / pathology*
  • Uterine Cervical Neoplasms / surgery
  • Young Adult