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Management of stage Ia1 squamous cervical cancer and the importance of excision margins: a retrospective study of long-term outcome after 25 years of follow-up.
- Source :
-
American journal of obstetrics and gynecology [Am J Obstet Gynecol] 2014 Dec; Vol. 211 (6), pp. 625.e1-6. Date of Electronic Publication: 2014 Jun 17. - Publication Year :
- 2014
-
Abstract
- Objective: The aim of this study was to assess the effect of the excision margin after cone for stage Ia1 cervical cancer on long-term outcomes.<br />Study Design: Retrospective observational study. Patients were divided into 3 groups. Group A underwent immediate reflex hysterectomy; group B had cervical intraepithelial neoplasia (CIN) at the margins but were followed up; group C had clear margins.<br />Results: We identified 111 women: 19 (17.1%) in group A; 29 (26.1%) in group B; and 63 (56.8%) in group C. Women in group A were older (median, 40 years vs 35 years; P = .0001) with higher rate of endocervical margin involvement (89.5 vs 48.1%, P = .007) than in group B. The women had been followed for a total of 960 woman-years with median follow-up of 398 weeks (quartiles: 258,612). Women with clear margins in the initial excision were more likely to remain free of disease than those with involved (P < .0001). Further surgery was required due to abnormal cytology in 9 (31.0%) women from group B and 7 (11.1%) from group C (P = .04). The cumulative rate of recurrent CIN2+ was 6.4% in group B and 2.7% in group C (P = .17). In group B, recurrences were more common in positive endocervical rather than ectocervical margins (66.6% vs 33.4%, P < .05); all had high-grade CIN at the margins.<br />Conclusion: The risk of posttreatment CIN2+ is substantially reduced when complete excision is achieved at first treatment. Conservative management is contraindicated in women with microinvasion at the margin. When CIN involves the margin, there is a greater risk of residual disease and of further treatment.<br /> (Copyright © 2014 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Age Factors
Aged
Carcinoma, Squamous Cell pathology
Cervix Uteri pathology
Disease Management
Female
Follow-Up Studies
Humans
Hysterectomy
Middle Aged
Neoplasm Staging
Neoplasm, Residual
Retrospective Studies
Treatment Outcome
Uterine Cervical Neoplasms pathology
Watchful Waiting
Young Adult
Carcinoma, Squamous Cell surgery
Cervix Uteri surgery
Conization
Neoplasm Recurrence, Local
Uterine Cervical Neoplasms surgery
Uterine Cervical Dysplasia pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1097-6868
- Volume :
- 211
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- American journal of obstetrics and gynecology
- Publication Type :
- Academic Journal
- Accession number :
- 24949540
- Full Text :
- https://doi.org/10.1016/j.ajog.2014.06.032