Necessity for subsequent surgery in women of child-bearing age with positive margins after conization

Wang, Xinmei; Xu, Juan; Gao, Yang; Qu, Pengpeng

doi:10.1186/s12905-021-01329-x

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…Here, the age of 35 y was also taken as the boundary to separate the age of menopause as this age group is of childbearing age and had one of the highest incidences of cervical lesions. We also found that age >35 y was a risk factor for positive margins after LEEP surgery (P = 0.033), which is consistent with the previous results (25). Previous studies showed that menopause was a risk factor for positive surgical margins (26,27), and our research also confirmed these findings.…”

Section: Discussionsupporting

confidence: 92%

“…At present, TCT and ECC are mainly used for cervical cancer screening and diagnosis, but their impact on prognosis is often ignored clinically. Patients with higher cytological atypia also have a higher probability of positive margins and residual lesions ( 25 ). Here, our study emphasizes the importance of preoperative cytological results for patient evaluation.…”

Section: Discussionmentioning

confidence: 99%

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Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Zhu

Chen

et al. 2022

Front. Med.

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IntroductionCurrently, the commonly used surgical methods for cervical lesions include loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). However, the positive rate of surgical margins after LEEP is relatively high, which leads to disease recurrence and places further demand on clinical treatment. This study investigated factors related to positive margins after LEEP and established a scoring system to enhance preoperative risk assessment and surgical selection.Materials and MethodsA retrospective analysis of the clinical data of 411 patients undergoing LEEP surgery for cervical lesions in the First Affiliated Hospital of University of Science and Technology of China (USTC), from January 2016 to March 2021, was performed. Cases were divided into a negative margin group (349 cases) and a positive margin group according to postoperative pathology. In the positive group (62 cases), single-factor and multi-factor analyses screened influencing factors; a logistic and additive scoring system was established; furthermore, a ROC curve was used to evaluate scoring effectiveness.ResultsThe positive rate of resection margins after LEEP was 15.1%. Univariate analysis indicated a relationship to patient age, menopause, preoperative ThinPrep Cytology Test (TCT) results, lesion quadrant number under colposcopy, cervical biopsy, and the result of endocervical curettage (ECC). Multivariate analysis showed that age >35 y, menopause, preoperative TCT being high-grade squamous intraepithelial lesion (HSIL), four quadrants being involved under colposcopy, and ECC being HSIL were all independent influencing factors of positive margins after LEEP (P < 0.05). These were included with the above factors to establish a logistic and additive scoring system. When the logistic score was 17, the sensitivity and specificity of predicting positive margins after LEEP were 80.6 and 61.6%, respectively. When the additive score was 6, the sensitivity and specificity were 74.2 and 66.2%, respectively. Both scoring systems had good predictability (area under the curve AUC >0.75).ConclusionsThis study quantified factors influencing positive margins after LEEP and established a scoring system for evaluating patients before surgery to provide a basis for individualized treatment and selection of surgical methods.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Zhu

Chen

et al. 2022

Front. Med.

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“… 20 Studies have found that age, menopausal status, and abnormal cytological testing are common risk factors for positive margins. 21 However, in our study, abnormal cytological testing and pathological margins were not associated with HPV infection status. Debaudrap et al 22 did a meta-analyses, showed that in the treatment of cervical precancerous lesions in HIV infected women, the failure rate of treatment with positive margins (47.2%, 95% CI 22.0–74.0) was significantly higher than that of patients with negative margins (19.4%, 95% CI 11.8–30.2).…”

Section: Discussioncontrasting

confidence: 70%

The Effect of Cervical Cold-Knife Conization (CKC) on HPV Infection in Patients with High-Grade Cervical Intraepithelial Neoplasia: A Retrospective Study

Gao,

Huang,

Wang

et al. 2023

IJWH

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Purpose Investigation of HPV infection treatment in women undergoing cervical cold-knife conization for advanced cervical intraepithelial neoplasia. Patients and Methods A retrospective analysis was conducted on patients who underwent cervical cold-knife conization for cervical intraepithelial neoplasia grade II–III at Beijing Obstetrics and Gynecology Hospital from January 2017 to December 2018. The HPV infection status of the patients at 6 months, 1 year, and 2 years after surgery was collected. We use chi square analysis and binary logistic regression to evaluate various factors such as age, number of pregnancies, number of cesarean sections, number of vaginal deliveries, HPV type, size of surgical specimens (diameter and height), and the influence of specimen edge on HPV infection. Results A total of 334 patients were included in the analysis. The patients are mainly infected with HPV 16/58/52. Age is a influencing factor for HPV recovery 12 months after CKC surgery (P=0.002). Based on the diagnosis of HPV one year after CKC, the recovery rate of HPV58 patients is significantly lower than HPV16. Age is a influencing factor for the recovery of HPV infection (P<0.05). Conclusion The treatment of HPV infection by CKC is related to the patient’s age and HPV subtype but not to number of pregnancies, number of pregnancies, number of vaginal deliveries, size of surgical specimens, and marginal conditions. The rate of HPV negative conversion is relatively high 24 months after the patient does not undergo surgery, but there is currently a lack of data on cervical lesions that match HPV results.

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“…Margin involvement is regarded as an important predictor of residual disease [ 5 , 14 , 26 ]. Repeated cervical conization is considered an acceptable alternative for women with a positive cone margin who desire fertility preservation, and hysterectomy is the definitive therapy for women with no reproductive requirements [ 27 , 28 ]. If the choice of treatment is new conization or hysterectomy, most women will unnecessarily undergo these procedures because they have no residual lesions.…”

Section: Discussionmentioning

confidence: 99%

Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design

Peng,

Liu,

Jiang

et al. 2023

BMC Women's Health

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Background This study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3. Methods This retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples. Results Overall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3–4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis. Conclusions Multiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.

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Necessity for subsequent surgery in women of child-bearing age with positive margins after conization

Cited by 7 publications

References 28 publications

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

The Effect of Cervical Cold-Knife Conization (CKC) on HPV Infection in Patients with High-Grade Cervical Intraepithelial Neoplasia: A Retrospective Study

Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design

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