Triage for management of cervical high-grade squamous intraepithelial lesion patients with positive margin by conization: a retrospective analysis
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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 reconization or re-assessment.
Keywordscervical high-grade squamous intraepithelial lesion conization positive surgical margin hysterectomy
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We thank the doctors and nurses at the Women’s Hospital, Zhejiang University School of Medicine, for providing the clinical information and grants supported by the Foundation of Science and Technology Department of Zhejiang Province, People’s Republic of China (Nos. 2012C13019-3 and N20130174), Special Fund for Scientific Research in the Public Interest from the National Health and Family Planning Commission of the People’s Republic of China (No. 201402010), and National Natural Science Foundation of China (Nos.81672568 and 81302248).
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