Skip to main content

Advertisement

SpringerLink
Log in

Predictive Factors for Residual Disease After Conization in Cervical Cancer

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to evaluate predictive factors for the presence of residual disease after conization followed by definitive surgery in cervical cancer, and suggest a margin distance threshold that could predict residual disease.

Methods

We retrospectively analyzed a series of 42 patients with early-stage cervical cancer who underwent primary conization before definitive surgical treatment from March 2009 to May 2020. All conization specimens were reviewed for endocervical, ectocervical, and radial margins. Cases with residual disease in magnetic resonance imaging before definitive surgery were excluded.

Results

Thirty-three (78.6%) patients underwent hysterectomies and 9 (21.4%) trachelectomies ± lymph node staging. Twelve (28.6%) cases were stage IA1, 5 (11.8%) cases were stage IA2, 13 (31%) cases were stage IB1, 11 (26.2%) cases were stage IB2, and 1 (2.4%) case was stage IIIC1 [International Federation of Gynecology and Obstetrics (FIGO) 2019]. We found residual disease in 17 (40.4%) surgical specimens. Of the 20 patients with negative margins, there were still 3 (15%) cases with residual disease. Conversely, residual disease was identified in 14 (63.6%) of the 22 patients with positive cone margins (p = 0.001). Tumor size [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.02–1.33] and positive endocervical margin status (OR 33.6, 95% CI 3.85–293.3) were related to a higher risk of residual disease in multivariate analysis. Notably, all patients with tumors larger than 2 cm had residual disease, in contrast to 29.4% in lesions up to 2 cm (p = 0.002).

Conclusion

We found that tumor size and positive margin were predictive factors for residual disease. We could not suggest a reliable minimum margin distance threshold that could predict residual disease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bentivegna E, Gouy S, Maulard A, Chargari C, Leary A, Morice P. Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. Lancet Oncol. 2016;17(6):e240–53. https://doi.org/10.1016/S1470-2045(16)30032-8.

    Article  PubMed  Google Scholar 

  2. Ramirez PT, Pareja R, Rendón GJ, Millan C, Frumovitz M, Schmeler KM. Management of low-risk early-stage cervical cancer: should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care? Gynecol Oncol. 2014;132(1):254–9. https://doi.org/10.1016/j.ygyno.2013.09.004.

    Article  PubMed  Google Scholar 

  3. Baiocchi G, de Brot L, Faloppa CC, et al. Is parametrectomy always necessary in early-stage cervical cancer? Gynecol Oncol. 2017;146(1):16–9. https://doi.org/10.1016/j.ygyno.2017.03.514.

    Article  PubMed  Google Scholar 

  4. Bentivegna E, Maulard A, Pautier P, Chargari C, Gouy S, Morice P. Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril. 2016;106(5):1195-1211.e5. https://doi.org/10.1016/j.fertnstert.2016.06.032.

    Article  PubMed  Google Scholar 

  5. Gien LT, Covens A. Gynecologic oncology fertility-sparing options for early stage cervical cancer. Gynecol Oncol. 2010;117(2):350–7. https://doi.org/10.1016/j.ygyno.2010.01.039.

    Article  PubMed  Google Scholar 

  6. Li X, Xia L, Chen X, Fu Y, Wu X. Simple conization and pelvic lymphadenectomy in early-stage cervical cancer: a retrospective analysis and review of the literature. Gynecol Oncol. 2020;158(2):231–5. https://doi.org/10.1016/j.ygyno.2020.05.035.

    Article  PubMed  Google Scholar 

  7. Suri A, Frumovitz M, Milam MR, Ramirez PT. Preoperative pathologic findings associated with residual disease at radical hysterectomy in women with stage IA2 cervical cancer. Gynecol Oncol. 2009;112(1):110–3. https://doi.org/10.1016/j.ygyno.2008.09.011.

    Article  PubMed  Google Scholar 

  8. Diaz ES, Aoyama C, Baquing MA, et al. Predictors of residual carcinoma or carcinoma-in-situ at hysterectomy following cervical conization with positive margins. Gynecol Oncol. 2014;132(1):76–80. https://doi.org/10.1016/j.ygyno.2013.11.019.

    Article  PubMed  Google Scholar 

  9. Roman L, Felix J, Muderspach L, Agahjanian A, Qian D, Paulmorrow C. Risk of residual invasive disease in women with microinvasive squamous cancer in a conization specimen. Obstet Gynecol. 1997;90(5):759–64. https://doi.org/10.1016/S0029-7844(97)00414-6.

    Article  CAS  PubMed  Google Scholar 

  10. Chang D-Y, Cheng W-F, Torng P-L, Chen R-J, Huang S-C. Prediction of residual neoplasia based on histopathology and margin status of conization specimens. Gynecol Oncol. 1996;63(1):53–6. https://doi.org/10.1006/gyno.1996.0277.

    Article  CAS  PubMed  Google Scholar 

  11. Phongnarisorn C, Srisomboon J, Khunamornpong S, et al. The risk of residual neoplasia in women with microinvasive squamous cervical carcinoma and positive cone margins. Int J Gynecol Cancer. 2006;16(2):655–9. https://doi.org/10.1111/j.1525-1438.2006.00399.x.

    Article  CAS  PubMed  Google Scholar 

  12. Hefler LA, Polterauer S, Schneitter A, et al. Repeat surgery in patients with cervical cancer stage FIGO IA1: a series of 156 cases and a review of the literature. Anticancer Res. 2010;30(2):565–8.

    PubMed  Google Scholar 

  13. Suri A, Frumovitz M, Milam MR, dos Reis R, Ramirez PT. Preoperative pathologic findings associated with residual disease at radical hysterectomy in women with stage IA2 cervical cancer. Gynecol Oncol. 2009;112(1):110–3. https://doi.org/10.1016/j.ygyno.2008.09.011.

    Article  PubMed  Google Scholar 

  14. Bai H, Cao D, Yuan F, et al. Accuracy of conization procedure for predicting pathological parameters of radical hysterectomy in stage Ia2–Ib1 (≤ 2 cm) cervical cancer. Sci Rep. 2016;6(Apr):1–8. https://doi.org/10.1038/srep25992.

    Article  CAS  Google Scholar 

  15. El-Nashar SA, Shazly SA, Hopkins MR, Bakkum-Gamez JN, Famuyide AO. Loop electrosurgical excision procedure instead of cold-knife conization for cervical intraepithelial neoplasia in women with unsatisfactory colposcopic examinations. J Low Genit Tract Dis. 2017;21(2):129–36. https://doi.org/10.1097/LGT.0000000000000287.

    Article  PubMed  Google Scholar 

  16. Jiang Y, Chen C, Li L. Comparison of cold-knife conization versus loop electrosurgical excision for cervical adenocarcinoma in situ (ACIS): a systematic review and meta-analysis. PLoS ONE. 2017;12(1):e0170587. https://doi.org/10.1371/journal.pone.0170587.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Smith B, McCann GA, Phillips G, et al. Less radical surgery for early-stage cervical cancer: can conization specimens help identify patients at low risk for parametrial involvement? Gynecol Oncol. 2017;144(2):290–3. https://doi.org/10.1016/j.ygyno.2016.11.029.

    Article  PubMed  Google Scholar 

  18. Tomao F, Maruccio M, Preti EP, et al. Conization in early stage cervical cancer: pattern of recurrence in a 10-year single-institution experience. Int J Gynecol Cancer. 2017;27(5):1001–8. https://doi.org/10.1097/IGC.0000000000000991.

    Article  PubMed  Google Scholar 

  19. Maneo A, Sideri M, Scambia G, et al. Simple conization and lymphadenectomy for the conservative treatment of stage IB1 cervical cancer. An Italian experience. Gynecol Oncol. 2011;123(3):557–60. https://doi.org/10.1016/j.ygyno.2011.08.009.

    Article  PubMed  Google Scholar 

  20. Bogani G, Chiappa V, Vinti D, et al. Long-term results of fertility-sparing treatment for early-stage cervical cancer. Gynecol Oncol. 2019;154(1):89–94. https://doi.org/10.1016/j.ygyno.2019.04.007.

    Article  PubMed  Google Scholar 

  21. Slama J, Cerny A, Dusek L, et al. Results of less radical fertility-sparing procedures with omitted parametrectomy for cervical cancer: 5 years of experience. Gynecol Oncol. 2016;142(3):401–4. https://doi.org/10.1016/j.ygyno.2016.07.008.

    Article  PubMed  Google Scholar 

  22. Raju SK, Papadopoulos AJ, Montalto SA, et al. Fertility-sparing surgery for early cervical cancer-approach to less radical surgery. Int J Gynecol Cancer. 2012;22(2):311–7. https://doi.org/10.1097/IGC.0b013e3182370f51.

    Article  PubMed  Google Scholar 

  23. Andikyan V, Khoury-Collado F, Denesopolis J, et al. Cervical conization and sentinel lymph node mapping in the treatment of stage I cervical cancer: is less enough? Int J Gynecol Cancer. 2014;24(1):113–7. https://doi.org/10.1097/IGC.0000000000000034.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, Brazil

    Glauco Baiocchi MD, PhD, Thiago Pereira Diniz MD, Bruna Tirapelli Gonçalves RN, MSc, Lillian Yuri Kumagai MD, Henrique Mantoan MD, Carlos Chaves Faloppa MD, PhD & Levon Badiglian-Filho MD, PhD

  2. Department of Anatomic Pathology, AC Camargo Cancer Center, São Paulo, Brazil

    Graziele Bovolim MD & Louise De Brot MD, PhD

  3. Department of Medical Oncology, AC Camargo Cancer Center, São Paulo, Brazil

    Andrea Paiva Gadelha Guimaraes MD & Alexandre Andre Balieiro Anastacio da Costa MD, PhD

Authors
  1. Glauco Baiocchi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thiago Pereira Diniz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Graziele Bovolim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bruna Tirapelli Gonçalves RN, MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lillian Yuri Kumagai MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Henrique Mantoan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Carlos Chaves Faloppa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Andrea Paiva Gadelha Guimaraes MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexandre Andre Balieiro Anastacio da Costa MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Levon Badiglian-Filho MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Louise De Brot MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GB, HM, TPD, GBov: study concept and design; TPD, CCF, GB, HM, BTG, GBov: data acquisition; GB, LYK, LDB, BTG, APGG: quality control of data; GB, LDB, LBF, APGG, GBov: data analysis and interpretation; GB, TPD, AABAC: statistical analysis; TPD, GB, AABAC; GBov: manuscript preparation and editing; All authors: manuscript review

Corresponding author

Correspondence to Glauco Baiocchi MD, PhD.

Ethics declarations

Disclosure

Glauco Baiocchi, Thiago Pereira Diniz, Graziele Bovolim, Bruna Tirapelli Gonçalves, Lillian Yuri Kumagai, Henrique Mantoan, Carlos Chaves Faloppa, Andrea Paiva Gadelha Guimaraes, Alexandre Andre Balieiro Anastacio da Costa, Levon Badiglian-Filho, and Louise De Brot declare no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baiocchi, G., Diniz, T.P., Bovolim, G. et al. Predictive Factors for Residual Disease After Conization in Cervical Cancer. Ann Surg Oncol 28, 6673–6681 (2021). https://doi.org/10.1245/s10434-021-09656-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-021-09656-x

Search

Navigation