| Backgrounds andObjectives:Cervical cancer is the most common malignant gynecological carcinoma in China, and the onset age of cervical cancer and precancerous lesion shows a younger trend. Cervical conization play an important role in diagnosis of cervical intraepithelial neoplasia (CIN) and cervical cancer. With the younger trend of cervical cancer and the postponed age of childbearing in Chinese women, cervical conization is gradually widely used in CIN treatment and in fertility preserving treatment of early stage cervical carcinoma. However, there are still some patients required repeat operation, including the conization or hysterectomy, for some reasons after cervical conization. Meanwhile, some patients required repeat operation due to fear of cancer or other causes, even if they do not have a indication for second surgery. Some patients require preserving uterus, even if they had completed their childbearing. The project aims (1) to analyze the clinical and pathological characteristics of cases with repeat surgery following cervical conization, (2) to compare pathological results of cervical biopsy, conization and repeat surgery, (3) to analyse of residual lesion after conization, (4)explore the predictors of residual lesion after conization.Methods:Objects of study were inpatients who underwent repeat surgery within 3 months after cervical conization in Qilu Hospital of Shandong University. Patients’ clinical characteristics and pathological findings were collected including name, hospital number, age, telephone number, home address, medical reasons, pregnancy history, menopause status, gynecological complications, cervical cytology, HPV examination before operation, time and place of biopsy, number of punch biopsy, pathological results of punch biopsy and endocervical curettage, colposcopic examination, pathology consultation, method and pathological diagnosis of conization, cervical cancer stage, surgical approach and name of repeat operation, pathological findings of second surgical sample, status of lymph node, and adjuvant therapy after reoperation. All final diagnosis were made according to the worst pathological diagnosis results of cervical punch biopsy, conization and repeat surgery. The stage of cervical cancer were made according to criteria of International Federation of Gynecology and Obstetrics in 2014.Results:Total 170 cases met inclusion criteria of this project,55 cases of high-grade squamous intraepithelial lesions (HSIL) accounting for 32.4%,72 cases of FIGO stage IA cervical squamous cell carcinoma (SCC), accounting for 42.4%; 28 cases of FIGO stage IB SCC accounting for 16.5%; 15 cases of cervical glandular epithelium tumor, accounting for 8.8%, including 5 cases of adenocarcinoma in situ (AIS) and 10 cases of invasive adenocarcinoma.(1) 55 cases of HISL:2 cases underwent reconization and 53 cases hysterectomy. The factors determined these 53 cases of hysterectomy were as followed:37.7% (20/53) were positive margin or lesion close to margin,13.2%(7/53) with hysteromyoma and adenomyosis,30.2%(16/53) with menostasis or old age or difficulty in folloe-up,2 cases with positive ECC,4 cases with HSIL or invasive cancer in deep cone tissue,4 cases without indication but "cancer phobia". The high grade CIN residual rate in repeat surgical sample was 31%(17/55).(2) 72 cases of stage IA SCC who underwent repeat surgery after conization:The pathological results of punch biopsy were as follow,62.5%(45/72) of HSIL, 27.8%(20/72) of HSIL with pathologic suspicion of invasion, only 7 cases of HSIL with microinvasion. The pathological results of repeat operation were as follow,63.9%(46/72) of cervicitis,6.9%(5/72) of LSIL,13.9%(10/72) of HSIL, 15.3%(11/72) of invasive cancer. The rate of residual lesions (HSIL and invasive cancer) was 29.2%(21/72). The rate of residual lesions in cases with multifocal tumor invasion was 52.9%(9/17), significantly higher than that 21.8%(12/55) with unifocal tumor invasion, the difference was statistically significant.(3) 28 cases of stage IB SCC who underwent repeat surgery after conization:The final clinicopathological diagnosis was 25 cases of stage IB1 SCC and 3 cases of stage IB2 SCC. The pathological diagnosis of CDB before conization were as follow,16 cases of HSIL,9 cases of HSIL with pathologic suspicion of invasion and 3 cases of invasive cancer.The pathological results showed that 60.7%(17/28) has residual HSIL or cancer, and 39.3%(11/28) were cervicitis. Among these 28 cases,42.9%(12/28) had LVSI and 21.5%(6/28) had pelvic lymph nodemetastasis.(4) Among 5 cases of AIS,1 case has residual HSIL and 4 with cervicitis in repeat surgical samples. Among 10 cases of cervical adenocarcinoma,4 has residual adenocarcinoma,1 with AIS and 5 with cervicitis second operation.Conclusions:(1) Colposcopy-directed biopsy has the risk of undiagnosis of cervical carcinoma, and it could not replace diagnostic cervical conization.(2) Negative margins of cervical conization specimens do not assure no residual tumor, and a part of them may have residual lesions.(3) Multifocal tumor invasion was a predictor of residual lesion in repeat surgery after cervial conization in patients with stage IA cervical cancer.(4) To make a dicision about whether repeat operation after cervial conization, patients’age, condition of fertility, pathologic results of conization and follow-up should be taken into consideration, and then make individualized management. |
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