Cervical cone dimension and linear CIN extension trend: 28 years' experience of a tertiary center

Objective: To evaluate trend in cervical cone length and CIN linear extension in women treated in a tertiary referral centre over a 28 years period. Methods: A retrospective study including 3716 women treated with cervical conization for biopsyproven HSIL (CIN grade 2 and 3), glandular lesions and microinvasive squamous cervical cancer from 1992 to 2020. Relevant clinical and histopathological data were collected. Results: A mean cone length of 9.5 mm (SD 5.1 mm, range 1–40 mm) and CIN linear extension of 6.58 mm (SD 3.38 mm, range 1–45 mm) were found. A 35% significant decrease in cone length was observed in the 28 years period, while no differences were found in CIN extension. Furthermore, ectocervical and endocervical margin positivity rates were stable over the study period and not affected by decreasing cone length. Conclusion: The current study reported a signif-icant trend of reduction in cone length from 1992 to 2020 while margin status was unaffected. This may reflect less invasive approach and increased attention to obstetric outcomes.

Cervical intraepithelial neoplasia; Screening; Cervical conization; Cone dimen-sion; Linear CIN extension

[1] Arbyn M, Raifu AO, Weiderpass E, Bray F, Anttila A. Trends of cervical cancer mortality in the member states of the European Union. European Journal of Cancer. 2009; 45: 2640–2648.

[2] Bucchi L, Baldacchini F, Mancini S, Ravaioli A, Giuliani O, Vat-tiato R, et al. Estimating the impact of an organised screening programme on cervical cancer incidence: a 26-year study from northern Italy. International Journal of Cancer. 2018; 144: 1017–1026.

[3] Bucchi L, Mancini S, Baldacchini F, Giuliani O, Ravaioli A, Vat-tiato R, et al. Changes in the incidence of cervical tumours by disease stage in a cytology-based screening programme. Journal of Medical Screening. 2020; 27: 96–104.

[4] Melnikow J, McGahan C, Sawaya GF, Ehlen T, Coldman A. Cervical Intraepithelial Neoplasia Outcomes after Treatment: Long-term Follow-up from the British Columbia Cohort Study. Journal of the National Cancer Institute. 2009; 101: 721–728.

[5] Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P, et al. Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. British Medical Journal. 2016; 354: i3633.

[6] Ciavattini A, Clemente N, Liverani CA, Cattani P, Giannella L, Delli Carpini G, et al. Cervical Excision Procedure: a Trend of Decreasing Length of Excision Observed in a Multicenter Survey. Journal of Lower Genital Tract Disease. 2017; 21: 279–283.

[7] Sopracordevole F, Clemente N, Delli Carpini G, Giorda G, Del Fabro A, Moriconi L, et al. Trend of decreasing length of cervical cone excision during the last 20 years. European Review for Medical and Pharmacological Sciences. 2017; 21: 4747–4754.

[8] Liverani CA, Di Giuseppe J, Clemente N, Delli Carpini G, Monti E, Fanetti F, et al. Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia (CIN 2–3) is a predictor of pregnancy outcome. European Journal of Cancer Prevention. 2016; 25: 416–422.

[9] Kurman R, Carcangiu ML, Herrington CS, Young YR. WHO classification of tumors of female reproductive organs. World Health Organization Classification of Tumors. Lyon: International Agency for Research on Cancer. 2014.

[10] Phadnis SV, Atilade A, Bowring J, Kyrgiou M, Young MPA, Evans H, et al. Regeneration of cervix after excisional treatment for cervical intraepithelial neoplasia: a study of collagen distribution. BJOG: an International Journal of Obstetrics and Gynaecology. 2011; 118: 1585–1591.

[11] Martens JE, Smedts FMM, Ploeger D, Helmerhorst TJM, Ramaekers FCS, Arends JW, et al. Distribution pattern and marker profile show two subpopulations of reserve cells in the endocervical canal. International Journal of Gynecological Pathology. 2009; 28: 381–388.

[12] Ueki M, Ueda M, Kurokawa A, Morikawa M, Kusakabe T. Cytologic study of the tissue repair cells of the uterine cervix. with special reference to their origin. Acta Cytologica. 1992; 36: 310–318.

[13] Maina G, Ribaldone R, Danese S, Lombardo V, Cavagnetto C, Plazzotta C, et al. Obstetric outcomes in patients who have under-gone excisional treatment for high-grade cervical squamous intraepithelial neoplasia. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2019; 236: 210–213.

[14] Lara-Peñaranda R, Rodríguez-López PM, Plitt-Stevens J, Ortiz-González A, Remezal-Solano M, Martínez-Cendán JP. Does the trend toward less deep excisions in LLETZ to minimize obstetric risk lead to less favorable oncological outcomes? International Journal of Gynecology & Obstetrics. 2020; 148: 316–324.