2017, Volume 11, Issue 2
Frontiers of Medicine >> 2017, Volume 11, Issue 2 doi: 10.1007/s11684-017-0517-8
Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization: a retrospective analysis
1. Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
2. Key Laboratory of Women’s Reproductive Health of Zhejiang Province, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China.
3. Department of Obstetrics & Gynecology, Southwest Hospital, Third Military Medical University, Chongqing 400000, China.
4. Ningbo No.2 Hospital, Ningbo 315000, China
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Abstract
The objective of this study is to guide a triage for the management of cervical high-grade squamous intraepithelial lesion (HSIL) patients with positive margin by conization. Clinico-pathological data of HSIL patients with positive margin by conization were retrospectively collected from January 2009 to December 2014. All patients underwent secondary conization or hysterectomy within 6 months. The rate of residual lesion was calculated, and the factors associated with residual lesion were analyzed by univariate and multivariate analyses. Among a total of 119 patients, 56 (47.06%) patients presented residual HSIL in their subsequent surgical specimens, including 4 cases of invasive cervical carcinoma (3 stage IA1 and 1 stage IA2 patients). Univariate analysis showed that patient age>35 years (P=0.005), menopausal period>5 years (P=0.0035), and multiple-quadrant involvement (P=0.001) were significantly correlated with residual disease; however, multivariate analysis revealed that multiple-quadrant involvement (P=0.001; OR, 3.701; 95%CI, 1.496–9.154) was an independent risk factor for residual disease. Nearly half of HSIL patients with positive margin by conization were disease-free in subsequent surgical specimens, and those with multiple positive margins may consider re-conization or re-assessment.
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