Objectives Evaluate predictive factors for residual invasive cervical cancer after cone biopsy.

Methods We reviewed a series of 230 patients with early stage cervical cancer submitted to radical hysterectomy from 2008 to 2018. Of these, 47(20.4%) had diagnostic cone biopsy previous to radical hysterectomy and are subject of analysis.

Results Median age was 37 years and 26(55.3%) were squamous cell carcinomas. Overall, the cone biopsy had positive margins in 25(53.2%) cases - 22(46.8%) radial, 17(36.2%) endocervical and 15(31.9%) ectocervical margins. The median tumor size and depth of invasion in cone biopsy was 5mm (0.1–30) and 4mm (0.35–24), respectively. After radical hysterectomy, 20(42.6%) cases had residual disease. The median residual tumor size and depth of invasion after radical hysterectomy was 11mm (0.1–42) and 5mm (1–20), respectively. Any positive margin in cone biopsy influenced the presence of residual disease (p<0.001). Of the 25 patients with positive margins in cone biopsy, 17 (68%) had residual disease. Conversely, of the 22 patients with negative margins in cone biopsy, 3(13.6%) still had residual disease in radical hysterectomy. In cone biopsy, tumor size, depth of invasion, radial and endocervical free margins distance were not related to residual disease. However, ectocervical free margin distance correlated to the presence of residual disease (p<0.001). Moreover, no patient with free margin distance in cone biopsy of ≥1.5mm had residual disease.

Conclusions Presence of positive margins in conization related to a higher risk of residual disease in the hysterectomy specimen. Free margin distance in cone biopsy of <1.5mm may predict the presence of residual disease.