发表于中华医学杂志英文版， 2009;122(4):367-372

孙晓光 马水清 张晋夏吴鸣（英文文章）

背景：宫颈锥切是CIN的常用诊断治疗方法。但是术前怎样预测切缘能否切净？切缘阳性的意义是什 么？北京协和医院妇科孙晓光

目的：揭示能够预测阳性切缘的因素，分析阳性切缘的临床意义。

方法：2003-2005年，207例接受了锥切的CIN III 患者被纳入。研究地点： 北京协和医院。

结果：151例切净，37例临近切缘，19例切缘阳性（未切净）。单因素分析显示分娩次数、细胞学级别、活检时CINIII 占据了多象限、累腺、以及锥切深度是阳性切缘的预示因素。年龄、孕次、锥切的方法则不是预测的因素。多因素分析显示细胞学级别、锥切深度、分娩次数及多象限累及是有意义的预测因素。一部分患者锥切后接受了全子宫切除。其中36切净者仍有20例（56%）有CIN I 以上的病变。21例临近切缘者15例有CINI 以上的病变（71.4%）。10例切缘未净者8例有CIN I以上的病变（80%）。

结论：1 细胞学级别、锥切深度、产次、活检证明多象限受累是阳性切缘的预测因素。

          2 锥切的切缘是否干净不代表病变的存在与否，但是代表残余病变的可能性大小。所以锥切切缘的干净与否是宫颈癌前病变管理的一个有用的中间指标。

Predictors and clinical significance of the positive cone margin in
cervical intraepithelial neoplasia III patients
SUN Xiao-guang, MA Shui-qing, ZHANG Jin-xia and WU Ming

Beijing Union Medical College（Hospital）

Background Conization is being widely accepted for diagnosis and treatment of cervical intraepithelial neoplasia (CIN).There is controversy as to which factors are most predictive of a positive cone margin and the clinical significance of it.We conducted this study to identify the predictive factors and to evaluate the clinical significance of a positive cone argin in CIN III patients. methods A retrospective review was conducted of 207 patients who had undergone conization due to CIN III from anuary 2003 to December 2005 at Peking Union Medical College Hospital. Of these, 67 had a subsequent hysterectomy. nivariate and multivariate analysis were utilized to define the predictive factors for a positive cone margin, and to compare the pathologic results of conization with subsequent hysterectomy.Results One hundred and fifty-one (72.9%) were margin free of CIN I or worse, 37 (17.9%) had CIN lesions close to the margin and 19 (9.2%) had margin involvement. A total of 56 cases (27.1%) had positive cone margins (defined as the
presence of CIN at or close to the edge of a cone specimen). Univariate analysis showed that the parity, cytological grade,multi-quadrants of CIN III by punch biopsy, gland involvement, as well as the depth of conization were significant factorscorrelated with a positive cone margin (P <0.05). However the age, gravidity, grade of dysplasia in punch biopsy, as wellas the cone methods were not significantly correlated (P >0.05). Multivariate analysis revealed that the cytological grade(OR=1.92), depth of conization (OR=2.03), parity (OR=3.02) and multi-quadrants of CIN III (OR=4.60) were significantpredictors with increased risk for positive margin. The frequency of residual CIN I or worse in hysterectomy specimens
was found to be 55.6% (20/36) in patients who were margin free, 71.4% (15/21) in patients with CIN occurring close tomargin, and 80.0% (8/10) in patients with margin involvement. The frequency of residual CIN III or worse was found to be13.9% (5/36), 23.8% (5/21) and 50.0% (5/10) respectively in different groups.Conclusions Cytological grade, depth of conization, parity and multi-quadrants of CIN III in punch biopsy weresignificant factors with increased risk in predicting a positive cone margin. Margin status of conization did not mean thepresence or absence of CIN, but rather the varied frequency of residual CIN in specimens of subsequent hysterectomy.In view of this fact, it is suggested that the margin status of conization be a valuable surrogate marker for clinical
management of CIN III.