Authors H Addae Groote Schuur Hospital M Mhembere South African Medical Research Council T Adams University of Cape Town Keywords: margins, treatment failure, recurrence, crypt involvement Abstract

Background: Recurrent disease after cervical excisional procedures has been linked to many factors. We aim to determine whether positive margins and crypt involvement increased the rate of recurrence of premalignant disease in patients who underwent excisional procedures.

Methods: This study is a retrospective review of the colposcopy database, patient records and pathology database. Women who underwent cervical excisional procedures at the Groote Schuur Hospital colposcopy clinic during 2010 were followed up until 2015. Treatment failure was based on high grade cytology or histology at follow-up. Chi-square tests were used to compare treatment failure rates.

Results: In total, 270 women were included in the final analysis. Of these women, 130 had CIN III and 94 had CIN II at the excisional procedure. Also, 85 (31.5%) had endocervical margin involvement, 46 (17%) had ectocervical margin involvement, and 24 (8.9%) had dual margin involvement, while 213 (79.2%) of the women had crypt involvement. Treatment failure occurred in 30 (19.4%) of the 155 women for whom follow-up data were available. Of those that failed, 19 (p < 0.001) had positive endocervical margin involvement, 10 (p = 0.007) had ectocervical margin involvement, 9 (p < 0.001) had dual margin involvement, and 28 (p = 0.058) had crypt involvement. Conversely, 155 women (43%) were lost to follow-up.

Conclusion: Positive margins in excisional procedures of the cervix have a statistically significant increased risk of treatment failure. There was a trend towards treatment failure in those women who had crypt involvement.

Author Biographies H Addae, Groote Schuur Hospital

Department of Obstetrics and Gynaecology, Groote Schuur Hospital, South Africa

M Mhembere, South African Medical Research Council

South African Medical Research Council, University of Cape Town Gynaecological Cancer Research Centre (SA MRC UCT GCRC); UCT Global Surgery, South Africa

T Adams, University of Cape Town

University of Cape Town Gynaecological Cancer Research Centre ( SA MRC UCT GCRC); UCT Global Surgery, South Africa

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Original Research

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