Positive margins in cervical H-SIL conization: Can we predict them?

Abstract

Background: Cervical cancer is the second most common gynecological cancer in the female population. Cervical cancer screening includes cytology and tests for oncogenic subtypes of human papillomavirus (HPV), impacting on a significant decrease in mortality. In patients with a diagnosis of high-grade squamous intraepithelial lesion (HG SIL), the recommended management is excisional treatment (ET). The higher rate of persistent disease is associated with a positive margin status, larger lesion size, endocervical involvement and HPV positive test six months after treatment, especially HPV 16 subtype. Objective: To identify clinical and/or pathological features capable of predicting the compromise of the margins in the excisional treatment specimens. Methods: It is an observational, retrospective study carried out in Sanatorio Güemes between September 2017 and June 2020. All those patients with HG SIL who underwent excisional treatment were analyzed. The variables considered were the pre-treatment status of the endocervical canal, the size of the specimen (height), the type of transformation zone, the presence of greater pathology in the definitive specimen, the delay in consultation and the smoking habit. The relative risk of presenting compromised margins for each of the variables was analyzed. Findings: Our study shows 124 patients who received excisional treatment for HG SIL, 32 had compromised endocervical margins of the resection specimen. The delay in consultation between the biopsy and the ET has a significant impact on the state of the margins (RR 2,26; IC95 1,27-4; p 0,009). The presence of greater pathology (microinvasive carcinoma or higher stage) in the group with compromised margins (34,4% vs. 5,4%) highlights the importance of a comprehensive pre-treatment advisement to the patient concerning the diagnostic role of the ET in our population.