Prevalence and Risk Factors for Residual Cervical Neoplasia in Subsequent Hysterectomy Following LEEP or Conization
Jiraprapa Natee, MD*, Suwanit Therasakvichaya, MD, Dr med*, Dittakarn Boriboonhirunsarn MD, MPH , PhD*
Affiliation : *Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital, Mahidol University
Objectives : The purposes of the present study were to determine the prevalence of residual disease in the
hysterectomy specimens following cold knife conization (CKC) or loop electrosurgical excision procedure
(LEEP) and to evaluate the predictive factors for residual disease.
Design : Descriptive study
Setting : Department of Obstetrics and Gynecology, Faculty of Medicine, Siriraj Hospital.
Subjects : A total of 120 patients who underwent hysterectomy after either LEEP or CKC.
Materials and Methods : The medical records of 120 women were reviewed to estimate the prevalence of residual
disease.. The patients’ characteristic and pathologic parameters were analyzed for the risk factors of residual
disease. Chi square test and Student t test were used for statistical analysis.
Results : Of the 120 patients, 46 cases had residual disease in their hysterectomy specimens so the prevalence
was 38.3% (95% CI 29.5, 47.2). Invasive cervical cancer was found in the hysterectomy specimens in 4 cases
(8.7%). Only ectocervical margin was the predictive factor of residual disease in the hysterectomy specimen
(p = 0.002). Age, conization pathologic findings, glandular involvement, endocervical margin status, stromal
invasion, and endocervical curettage results were not predictive factors for residual disease in the hystectomy
specimens.
Conclusion : Residual disease was found in 38.3% of hysterectomy specimens after conization. Also undiagnosed
invasive cervical cancer was found. Careful examination for residual disease in hysterectomy specimens
should be performed, especially among those with positive cone margin.
Keywords : Cervical intraepithelial neoplasia, Cold knife conization, Loop electrosurgical excision procedure, Residual disease
