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Cone Biopsy and Pathologic Findings at Radical Hysterectomy in Stage I Cervical Carcinoma

From the Departments of Obstetrics and Gynecology, and Pathology, Division of Gynecologic Oncology, State University of New York Health Science Center, Brooklyn, New York; and Kings County Hospital, Brooklyn, New York.

Address reprint requests to: Kevin Holcomb, MD, Department of Obstetrics and Gynecology, Beth Israel Medical Center, Petrie Division, First Avenue at 16th Street, New York, NY 10003; E-mail: kholcomb{at}chpnet.org.

OBJECTIVE: To examine the association between cone biopsy and pathologic findings at radical hysterectomy in stage I cervical carcinoma.

METHODS: Fifty-four patients diagnosed by cone biopsy with stage I cervical carcinoma and treated with radical hysterectomy comprised the study group. The association between the depth of invasion on conization, lymph-vascular invasion, positive cone margins, positive endocervical curettage (ECC), and the depth of residual invasion in the radical hysterectomy specimen was examined using Pearson r and point biserial correlation. Independent predictors of the depth of residual invasion were determined by multiple regression.

RESULTS: The depth of residual invasion correlated significantly with the depth of invasion (r = .374) and presence of lymph-vascular invasion (r_pb = .372) in the conization specimen, post-cone ECC status (r_pb = .669), and age at diagnosis (r = .347). The same factors were jointly assessed using multiple regression (R² = .636, P< .001). Depth of invasion on conization, lymph-vascular invasion, and ECC status were identified as independent predictors of the depth of residual invasion. Patients with deep (5 mm or greater) stromal invasion and lymph-vascular invasion on conization had significantly higher rates of positive parametrial margins (22% compared with zero, P = .001) and adjuvant radiation (66.7% compared with 20%, P = .004) compared with all other patients.

CONCLUSION: Depth of invasion, presence of lymph-vascular invasion, and age at diagnosis were independent predictors of the depth of residual invasion in the subsequent hysterectomy specimen. These factors should be considered in treatment planning. Patients with a combination of these factors may have increased risk for deep residual invasion, positive hysterectomy margins, and adjuvant radiation.