The factors related to the remaining positive margin after cervical conization

Document Type : Original Article

Authors

1 Associate Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Resident, Department of Obstetrics and Gynecology, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Introduction: Continuation of the disease after cervical conization is probable. Knowing the risk factors involved can facilitate the selection of treatment methods and appropriate follow-up; therefore, this study was conducted with aim to determine the factors related to the remaining positive margin after cervical conization.
Methods: In this retrospective cross-sectional analytical study, the clinical records of all women ≥ 18 years with intra-epithelial neoplasia (CIN) type 3 who underwent cervical conization in Imam Hossein (A) Hospital of Tehran (2017-2022) were selected by total population sampling and effective factors on the condition of the internal margin after cervical conization were investigated. The data was analyzed by SPSS software (version 23) and t and Mann-Whitney statistical tests. P<0.05 was considered statistically significant.
Results: In this study, 100 people were investigated that a positive margin was found in 27 people (0.27%). Human papillovirus (HPV) infection (OR = 1.810, 95% CI = 0.071-2.74, P = 0.001), old age (OR = 0.630, 95% CI = 0.092-1.02, P = 0.002) and menopause (OR = 0.815, 95% CI = 0.096-1.32, P = 0.004), respectively with the highest chance had increased the possibility of a positive margin after cervical conization.
Conclusion: Old age, menopause and HPV infection are among the risk factors of positive margin after cervical cone removal.

Keywords

Main Subjects


  1. Taherkhani N, Taherkhani R. Application of mathematical modeling in the Diagnosis and Treatment of Diseases (Case: Type 2 Diabetes and Cancer). In1st National Conference on Mathematics and Engineering Sciences with Applied Knowledge Approach 2015:26-27.
  2. Berek JS, Novak E. Berek & Novak's Gynecology. 15nd Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.
  3. Behtash N, Karimizarchi M. Cervical cancer: The preventive role of HPV vaccine. Tehran University of Medical Sciences Journal 2006; 64(12):1-8.
  4. Nejati A, Mirteimouri M, Nikdoust S, Nikdoust M, Alizadeh F. Human Papillomavirus (HPV) test and Pap Smear in Screening for Cervical Cancer: A systematic review on systematic review study. Iran J Obstet Gynecol Infertil 2020; 23(7):88-96.
  5. Mofrad MH, Jedi L, Ahmadi S. The role of human papilloma virus (HPV) vaccines in prevention of cervical cancer. Iran J Obstet Gynecol Infertil 2016; 19(21):22-9.
  6. Hasanzadeh Mofrad M, Karami Dehkordi A, Mozaffar Tizabi N, Amirian M. Survey of sexual dysfunction in women with cervical cancer and a history of pelvic radiation therapy in 2009 to 2013 in Ghaem and Omid hospitals, Mashhad. Iran J Obstet Gynecol Infertil 2015; 18(144):9-18.
  7. Hosseini S, Hasanzadeh Mofrad M, Aghel E, Homaei Shandiz F, Yousofi Z, Shahid Sales S, et al. Treatment complication, pathologic response and survival rate after chemotherapy before surgery in locally advanced cervical cancer. Iran J Obstet Gynecol Infertil 2020; 22(12):1-0.
  8. Jafarian AH, Mohamadian Roshan N, Gharib M, Mehrad-Majd H, Ahrari Roudi A. Immunohistochemical Expression of NQO1 in Premalignant Lesions and Squamous Cell Carcinoma of Cervix and its Correlation with Histopatholigic Factors. Iran J Obstet Gynecol Infertil 2023.
  9. Sharifi N, Yousefi Z, Saeed S, Bahreyni M, Davar Panah M. The Correlation between Ki67 Proliferative Marker and the Reactivity and Site of Cervical Intraepithelial Lesions. Iran J Obstet Gynecol Infertil 2010; 13(5):13-9.
  10. Mahmoudi P, Karimi E, Rezaei M. Improvement for rapid diagnosis of cervical cancer (Intra-epithelial) based on human Papilloma Virus type 16 and 18 using electrochemical biosensor. Iran J Obstet Gynecol Infertil 2019; 22(4):87-96.
  11. Ghahramani M, Alami A, Mohammad Zade Moghaddam H, Moodi M. Screening for cervical cancer: An educational intervention based on transtheoretical models and health belief in women of Gonabad, Iran. Iran J Obstet Gynecol Infertil 2018; 21(5):22-32.
  12. Yousefi Z, Hasanzadeh MM, Afzalaghaee M, Sharifi N, Jafarian M. Evaluation of related factors of remained dysplasia after treatment of cervical intraepithelial neoplasia by cold knife conization (longitudinal study). Iran J Obstet Gynecol Infertil 2014; 17(119): 1-7.
  13. Ghafoori F, Sabzeh Noughabi Z, Sarafraz N, Pourreza A. Sexual outcomes in women with cervical cancer: a review article. Iran J Obstet Gynecol Infertil 2016; 19(28):22-7.
  14. Goldhaber-Fiebert JD, Stout NK, Ortendahl J, Kuntz KM, Goldie SJ, Salomon JA. Modeling human papillomavirus and cervical cancer in the United States for analyses of screening and vaccination. Population Health Metrics 2007; 5:1-9.
  15. The American Cancer Society. What are the key statistics about cervical cancer? Available from: http://www.cancer.org/Cancer/CervicalCancer/DetailedGuide/cervicalcancer-key-statistics/2012.
  16. Rock JA, Jones HW. Te Linde’s Operative Gynecology. 10nd Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2008.
  17. Berek JS. Berek & Novak’s Gynecology. 14nd Philadelphia: Lippincott Williams and Wilkins; 2007.
  18. Ge Y, Liu Y, Cheng Y, Liu Y. Predictors of recurrence in patients with high-grade cervical intraepithelial neoplasia after cervical conization. Medicine 2021; 100(27).
  19. Giannella L, Di Giuseppe J, Prandi S, Carpini GD, Tsiroglou D, Ciavattini A. What is the value of pre-surgical variables in addition to cone dimensions in predicting cone margin status?. European Journal of Obstetrics & Gynecology and Reproductive Biology 2020; 244:180-4.
  20. Aluloski I, Tanturovski M, Petrusevska G, Jovanovic R, Kostadinova-Kunovska S. Factors That Influence Surgical Margin State in Patients Undergoing Cold Knife Conization–A Single Center Experience. prilozi 2017; 38(3):113-20.
  21. Minareci Y, Ak N, Tosun OA, Sozen H, Disci R, Topuz S, et al. Predictors of high-grade residual disease after repeat conization in patients with positive surgical margins. Ginekologia polska 2022; 93(12):962-7.
  22. Ikeda M, Mikami M, Yasaka M, Enomoto T, Kobayashi Y, Nagase S, et al. Association of menopause, aging and treatment procedures with positive margins after therapeutic cervical conization for CIN 3: a retrospective study of 8,856 patients by the Japan Society of Obstetrics and Gynecology. Journal of Gynecologic Oncology 2021; 32(5).
  23. Bogani G, Pinelli C, Chiappa V, Martinelli F, Lopez S, Ditto A, et al. Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women. Journal of Gynecologic Oncology 2020; 31(5).
  24. Bilibio JP, Monego HI, Binda ML, Dos Reis R. Menopausal status is associated with a high risk for residual disease after cervical conization with positive margins. PLoS One 2019; 14(6):e0217562.
  25. Purut YE, Giray B, Akis S, Peker EK, Babayeva G, Kabaca C, et al. Effect of Human Papillomavirus Subtype on the Rate of Positive Surgical Margin After Cervical Conization. International Journal of Surgical Pathology 2023; 31(1):20-5.