Invasive carcinoma after cone biopsy for cervical intraepithelial neoplasia.

A retrospective review of 578 patients with invasive cervical cancer identified 8 patients with a history of one or more cone biopsies for treatment of cervical intraepithelial neoplasia. The cone biopsy and hysterectomy specimens were reviewed to identify factors predictive of the subsequent development of invasive cancer. The mean interval from cone biopsy to diagnosis of invasive carcinoma was 6.7 years (range 1.5-16.5 years). High-grade intraepithelial neoplasia is a potentially invasive lesion. Adenocarcinoma in situ was identified as a high-risk lesion that may be inadequately treated by cone biopsy. Four patients developed invasive squamous cancer in spite of complete excision of the initial lesion. Patients who have high-grade intraepithelial neoplasia treated with cone biopsy require long-term follow-up, and conization may hamper the subsequent diagnosis of preinvasive lesions.