Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design

Abstract

Background This study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3. Methods This retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples. Results Overall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3–4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis. Conclusions Multiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

“…At the same time, the most important reason was that we did not conduct iodine tests or acetic acid tests before performing the LEEP, so the scope of the lesion could not be well observed. In subsequent LEEP, it is recommended that all patients undergo iodine or acetic acid tests to determine the specific location and extent of the lesions [ 25 ]. These findings may explain the increased percentage of positive margins in this study.…”

“…Therefore, patients desired an immediate result [ 27 ]. The second group included patients with other diseases requiring surgical treatment, such as uterine fibroids and adenomyopathy [ 25 ]. Finally, a small number of menopausal patients had cervical atrophy, and there was no chance to perform the LEEP; therefore, patients demanded total hysterectomy.…”