Abstract:

Background and purpose: Repeat conization is a conservative surgical choice for the treatment failure after primary conization in patients with cervical intraepithelial neoplasia (CIN), however, there were limited evidences to show its efficacy and safety. The aim of the present study was to evaluate the treatment and diagnostic value of repeat conization in the management of residual or recurrent CIN. Methods: From 2003 to 2010, 65 CIN patients underwent repeat conization for positive margin, persistent or recurrent disease after primary conization in Fudan University Shanghai Cancer Center. The medical records and pathological slides were reviewed on histopathological outcomes, margin involvement, complications during and after repeat conization, and reappearance of CIN lesions during follow-up, as well as obstetric outcomes. Results: Among the 50 patients for the treatment of positive margin after primary conization, invasive carcinoma was confirmed in 2(4.0%) patients (1 adenocarcinoma and 1 microinvasive squamous carcinoma), and residual CIN lesions were present in 23 patients (46.0%). In the rest 15 cases for the treatment of persistent or recurrent disease after primary conization, 11(73.3%) patients had CIN lesions in the cone specimens, none had invasive carcinoma. After the secondary conization, 58 patients had clear margins. Involvement of the ectocervical or endocervical margins was found in 1 adenocarcinoma case and 6 CIN cases. Additional hysterectomy was carried out in the adenocarcinoma case, 3 cases with positive margin and 1 case with cervical occlusion and amenorrhea because of cervical adhesion. Massive hemorrhage was another severe complication and occurred in 2 cases. In the 60 cases who preserved their uteruses after secondary conization, reappearance of CIN disease was documented in 4 (6.7%) cases during the median follow-up of 41 months (25-87). Conclusion: Repeat conization appears to be a rational treatment choice for young patients with residual, persistent, recurrent CIN. Invasive carcinoma could be revealed in the repeat conization. Severe complication was uncommon, but needs active management.

Key words: Cervical intraepithelial neoplasia, Repeat conization, Residual disease, Recurrence