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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2017, Vol. 11 Issue (2) : 223-228     DOI: 10.1007/s11684-017-0517-8
RESEARCH ARTICLE |
Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization: a retrospective analysis
Yuya Dou1,3, Xiaodan Zhang1,4, Yang Li1,2, Fenfen Wang1,2, Xing Xie1,2, Xinyu Wang1,2()
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.

Keywords cervical high-grade squamous intraepithelial lesion      conization      positive surgical margin      hysterectomy     
Corresponding Authors: Xinyu Wang   
Just Accepted Date: 28 March 2017   Online First Date: 10 May 2017    Issue Date: 01 June 2017
URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0517-8     OR     http://academic.hep.com.cn/fmd/EN/Y2017/V11/I2/223
Patient age (year)
Median
46.87
Range26–68
Interval between two operations (d)78.73±35.097
Pregnancy (n)
01
18
235
335
>340
Parity (n)
03
166
240
>210
Menopausal status (n)
No83
Yes34
Pre-cone cytology (n, %)
NILM2 (1.68)
ASC-US25 (21.00)
LSIL17 (14.29)
ASC-H18 (15.12)
HSIL57 (47.89)
Initial cone pathology (n, %)
CIN II9 (7.56)
CIN III110 (92.44)
Reoperation method (n, %)
CKC38 (31.93)
LEEP7 (5.88)
Hysterectomy
Tab.1  General characteristics of 119 HSIL patients with positive margin by conization
ParametersAge (year)Menopause time (year)Pregnancy (n)Parity (n)Pre-cone cytologyBiopsy pathologyInitial conizationHSIL in ECCPositive margin siteInvolved quadrant(s)FIGO stage
Case 156122NILMHSILLEEPNotEndoMulti-IA 1
Case 2651331HSILHSILCKCInvolvedEndoMulti-IA 1
Case 356521HSILHSILLEEPNotEndoMulti-IA 2
Case 437No10ASC-USHSILCKCNotEndoMulti-IA 1
Tab.2  Characteristics of patients with residual cervical carcinoma
ParametersResidual rate
n (%)
Univariate analysisMultivariate analysis
P valueP valueOR (95%CI)
Age (year)≤351/12 (8.33)0.005*0.004*0.04 (0.876–8.422)
>3555/107 (51.40)
Menopausal statusNo36/83 (43.37)0.156NS**
Yes20/34 (58.83)
Menopausal time (year)≤55/14 (35.71)0.035*NS
>515/20 (75.00)
Pregnancy≤218/44 (40.91)0.345NS
>238/75 (50.67)
Parity≤130/69 (43.48)0.457NS
>126/50 (52.00)
Pre-cone cytology≤LSIL16/44 (36.36)0.075NS
ASC-H7/18 (38.89)
HSIL33/57 (57.89)
Initial conizationLEEP34/66 (51.52)0.356NS
CKC22/53 (41.51)
HSIL in ECCNo37/82 (45.12)0.557NS
Yes19/37 (51.35)
Positive siteEndo49/99 (49.49)0.488NS
Ecto4/12 (33.33)
Endo/Ecto/base3/8 (37.50)
Involved quadrant(s)Multiple10/44 (22.73)0.001*0.005*3.701(1.496–9.154)
Single75 (61.33)
Tab.3  Analysis on factors correlated with residual lesion in HSIL with positive margin
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