<p>Risk Factors for Residual Disease in Hysterectomy Specimens After Conization in Post-Menopausal Patients with Cervical Intraepithelial Neoplasia Grade 3</p>

Abstract

Background Post-menopausal patients with cervical intraepithelial neoplasia (CIN) have a high rate of residual or recurrent lesions after treatment, and their risk for cervical cancer later in life is higher than the general population. Hence, management for this specific group of post-menopausal patients needs more attention. Objective The study aimed to identify risk factors associated with the presence of residual disease in hysterectomy specimens in post-menopausal patients with cervical intraepithelial neoplasia grade 3 (CIN 3). Methods This study was a retrospective analysis of data from post-menopausal women who had undergone hysterectomy following conization for CIN 3 from 2012 to 2018 at Fujian Maternity and Child Health Hospital. Factors extracted from the database included age, parity, Thinprep cytology results, human papillomavirus (HPV) genotype, biopsy results, pre-cone endocervical curettage (ECC) results, conization method, operating surgeon, cone dimension, margin status and glandular involvement. Univariate and multivariate analyses were performed to identify risk factors associated with residual disease in hysterectomy specimens. Results Analysis of data from 129 women was performed. The proportion of residual disease was 43.41% overall. A higher grade according to colposcopy biopsy, abnormal pre-cone ECC results, the cone method (LEEP vs CKC), a cone volume >1.57 cm 3 , and positive margins in conization specimens were found to be significantly associated with residual lesions on univariable analysis. After multivariate analysis, only an abnormal pre-cone ECC result (odds ratio 3.99; 95% confidence interval (CI) 1.41–11.33; p = 0.009) remained significant. Conclusion The rate of residual lesions in uterine specimens was high regardless of the cone margin status in post-menopausal women with CIN 3. Risk-based strategies are needed to identify patients who have abnormal pre-cone ECC results, and definitive treatment with hysterectomy should be considered in post-menopausal patients with an elevated risk for residual lesions.

Risk factors for recurrence of cervical intraepithelial neoplasia after loop electrosurgical excisional procedure in patients with positive margins

“…Other studies investigated the optimal size of the specimen to avoid positive margins or recurrence and determined the volume of specimens using the semi-ellipsoid volume formula (2/3 Â π Â A Â B Â C), where A, B, and C refer to the length of three semi-axes of the ellipsoid. [22][23][24] However, these studies failed to find significant associations between the volume of the specimen and recurrence. However, we used a straightforward formula and found that the volume was related to recurrence.…”

“…The length, width, and depth were multiplied to calculate the specimen volume. Other studies investigated the optimal size of the specimen to avoid positive margins or recurrence and determined the volume of specimens using the semi‐ellipsoid volume formula (2/3 × π × A × B × C ), where A , B , and C refer to the length of three semi‐axes of the ellipsoid 22–24 . However, these studies failed to find significant associations between the volume of the specimen and recurrence.…”

HPV conversion rates after LEEP, cold-knife conization, and laser and drug therapy: A 4-year follow-up study

“…Therefore, timely treatment is essential. [9,10]The primary risk a b factors for persistent cervical lesions after LEEP are cytological abnormalities and positive high-risk HPV findings. [2] We found in our study found that cervical conization treatment was superior to laser and drug treatment for patients with co-infected HPV cervical lesions, especially in terms of HPV conversion.…”

“…[18] Risk factors for persistent cervical lesions after LEEP are mainly cytological abnormalities and positive HR-HPV test. [10,19] Cervical laser vaporization can be used to treat patients with cervical intermediately lesions who wish to preserve their fertility, with a 2-year recurrence rate of 18.9% and a retreatment rate of 12.6%, and a 5-year recurrence rate of 46.5% and a retreatment rate of 30.5%. Close follow-up is recommended for patients with glandular involvement, older age, large BMI to prevent recurrence and disease progression.…”

Predictors of high-grade residual disease after repeat conization in patients with positive surgical margins

“…The treatment for pre-invasive neoplastic lesions aims to prevent invasive cervical cancer development. Conization is accepted as the first-line treatment modality of patients with high-grade cervical intraepithelial neoplasia (CIN) and may be performed by cold-knife excision or loop electrosurgical excision procedure (LEEP) [1]. However, in some cases, high-grade CIN lesions cannot be completely excised at the time of conization, exposing the patient to an increased risk of developing cervical cancer [2].…”