Risk Factors for Occult Invasive Cervical Cancer in Women with Abnormal Cervical Screening and Infeasible Diagnostic Conization.

PURPOSE: To review the incidence and predictive factors of invasive cervical cancer in women who underwent hysterectomy due to an abnormal cervical cytology and/or colposcopy biopsy when cervical conization was considered technically not feasible. PATIENTS AND METHODS: A retrospective study was conducted on 450 women who underwent hysterectomy due to an abnormal cytology and/or colposcopy biopsy at the Obstetrics and Gynecology Hospital of Fudan University between January 2020 and July 2023. Colposcopy was performed to evaluate all patients and it was determined that cervical conization was not feasible. RESULTS: The average age of the women was 61.9±7.9 years. Seventy-five (16.7%) women were identified with invasive cervical cancer. A multivariate logistic regression analysis indicated that cytology of high grade/ cancer (odds ratio [OR] 2.33, 95% confidence interval [CI] 1.48-4.58, p = 0.01), HPV16/18 infection (OR 4.62, 95% CI 2.42-7.94, p < 0.001), high-grade squamous intraepithelial lesion (HSIL) of endocervical curettage (OR 2.45, 95% CI 1.40-4.68, p = 0.02), and cervical masses and/or abnormal echoes detected by ultrasound (OR 10.70, 95% CI 4.29-27.72, p < 0.001) were predictive factors for invasive cervical cancer. Frozen sections appear to be an appropriate option for intraoperative identification of invasive cervical cancer. CONCLUSION: In elderly women with abnormal cervical cancer screening results and technically infeasible cervical conization, the incidence of invasive cervical cancer is considerable. Adequate preoperative imaging assessment and the utilization of intraoperative frozen sections may contribute to appropriate surgical options. The subsequent diagnostic and treatment plan should be determined according to the postoperative pathological findings, and additional surgery or other adjuvant therapy may be required.