Lugol’s solution reduces positive resection margins and residual disease after the loop electrosurgical excision procedure

Abstract

Background: The gold standard of treatment for cervical intraepithelial neoplasia (CIN) is cervical conization. There remains a concern regarding the residual disease if resection is incomplete. However, few studies have so far examined the methods to improve the complete resection of the entire lesion with LEEP, eg, applying Lugol’s solution during LEEP. We examined whether the use of Lugol’s solution reduces the proportion of positive resection margins after the loop electrosurgical excision procedure (LEEP). Methods: A total of 1,751 consecutive women with cervical intraepithelial neoplasia (CIN) who underwent LEEP at three university hospitals were retrospectively retrieved from the database. Outcomes included positive resection margins and residual disease pathologically confirmed within 6 months after LEEP. Results: Positive resection margins were noted in 345 (19.7%) cases. Among 1,507 women followed up, residual disease was diagnosed in 100 (6.6%) cases (69/308 cases with positive margins; 31/1,199 cases with negative margins). The Lugol’s solution group was less likely to have positive resection margins (11.8% vs. 25.5%; P < 0.01), to require additional surgical intervention (5.4% vs. 10.2%; P < 0.01), and to have residual disease (4.9% vs. 8.0%; P = 0.02). A multiple logistic regression analysis demonstrated that Lugol’s solution reduced the proportion of positive resection margins (adjusted odds ratio [aOR], 0.31), and that age 50 years or older (aOR, 1.64), pre-conization cervical cytology (aOR, 1.53), high-risk HPV (aOR 1.75), and CIN 2–3 (aOR, 2.65) were independent risk factors for margin positivity (P < 0.01 for all except high-risk HPV). Conclusions: Lugol’s solution optimizes CIN treatment by reducing the proportion of positive resection margins and residual disease after LEEP.