Predicting Persistent/Recurrent Disease in the Cervix After Excisional Biopsy

Sanjay M. Ramchandani, MD; Karen L. Houck, MD; Enrique Hernandez, MD; John P. Gaughan, PhD

Introduction

There is controversy as to which factors are most predictive of persistent or recurrent disease after cervical cold knife conization or loop electrosurgical excision procedure (LEEP).^{[1,2,3,4,5,6,7,8,9,10,11]} There is a lack of agreement on the usefulness of performing an endocervical curettage (ECC) at the time of excisional biopsy of the cervix and the ability of the ECC to help predict persistent disease above the site of excision.^{[12,13,14,15,16]} Recommendations for the clinical management of patients after conization are based on the histopathologic findings, the status of the surgical margin, patient's age and parity, patient's desire for future fertility, and concomitant upper genital tract pathology.

This retrospective observational study explored the ability of various factors to predict persistent/recurrent disease after a conization, with special attention to the ECC.

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Cite this: Predicting Persistent/Recurrent Disease in the Cervix After Excisional Biopsy - Medscape - May 01, 2007.

Table 1. Presence or Absence of Persistent/Recurrent Disease in Patients With Positive/Negative/TID Endocervical Curettage (ECC) and Ability of ECC to Predict Persistent/Recurrent Cervical Neoplasia
Endocervical Curettage
Follow-Up Findings	Positive No. (%) (95% CI)	Negative No. (%) (95% CI)	TID No. (%) (95% CI)	Total No. (%) (95% CI)
SIL/Cancer	16 (80) (56, 93)	19 (18.5) (72, 88)	6 (20.7) (9, 40)	41 (27) (20, 35)
Normal	4 (20) (66, 44)	84 (81.5) (72, 88)	23 (79.3) (60, 91)	111 (73) (65, 80)
Total	20 (100)	103 (100)	29 (100)	152 (100)

CI = confidence interval; TID = tissue insufficient for diagnosis; SIL = squamous intraepithelial lesion; sensitivity = 16/35 = 0.46 (95% CI: 0.29, 0.63); specificity = 84/86 = 0.96 (95% CI: 0.88, 0.99); positive predictive value = 16/20 = 0.80 (95% CI: 0.56, 0.94); negative predictive value = 84/103 = 0.82 (95% CI: 0.72, 0.88)

Table 2. Presence or Absence of Persistent/Recurrent Disease in Patients With Positive/Negative/TID Endocervical Curetting Specimens and Positive/Negative Endocervical Margin
	+ECC +Endo	-ECC -Endo	+ECC -Endo	-ECC +Endo	TID ECC +Endo	TID ECC -Endo	Total
Follow-Up Findings	No. (%) (95% CI)	No. (%) (95% CI)	No. (%) (95% CI)	No. (%) (95% CI)	No. (%) (95% CI)	No. (%) (95% CI)	No. (%) (95% CI)
SIL/Cancer	13 (100) (77, 100)	13 (14.3) (8, 24)	3 (42.9) (12, 80)	6 (50) (22, 78)	1 (20) (11, 70)	5 (20.8) (8, 43)	41 (27) (20, 35)
Normal	0 (--)	78 (85.7) (77, 92)	4 (57.1) (20, 88)	6 (50) (22, 78)	4 (80) (30, 99)	19 (79.2) (57, 92)	111 (73) (65, 80)
Total	13 (100)	91 (100)	7 (100)	12 (100)	5 (100)	24 (100)	152 (100)

Cox multivariate analysis, endocervical curetting specimens (OR, 8.710; 95% CI, 2.302, 32.958) and endocervical margin (OR, 9.170; 95% CI: 2.887, 29.125) together were significant predictors of persistent/recurrent disease having adjusted for the other variable. Cox multivariate analysis, endocervical curetting specimens (OR, 8.710; 95% CI: 2.302, 32.958) and endocervical margin (OR, 9.170; 95% CI: 2.887, 29.125) together were significant predictors of persistent/recurrent disease having adjusted for the other variable. CI = confidence interval; TID = tissue insufficient for histopathologic diagnosis; SIL = squamous intraepithelial lesion; Endo = endocervical margin; ECC = endocervical curetting specimens

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Predicting Persistent/Recurrent Disease in the Cervix After Excisional Biopsy

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