The effectiveness of cold-knife conization (CKC) for post-menopausal women with cervical high-grade squamous intraepithelial lesion: a retrospective study

Abstract

Background The effectiveness of surgery of high-grade squamous intraepithelial lesion in post-menopausal women needs to be investigated. This study evaluated the clinical significance of cold-knife conization in the diagnosis and surgery of cervical high-grade squamous intraepithelial lesions in post-menopausal women. Methods We conducted a retrospective analysis of post- and pre-menopausal patients with high-grade squamous intraepithelial lesion. All patients received cold-knife conization as the primary therapy. Results The satisfactory rate of colposcopy was significantly lower in the post-menopausal group than in the pre-menopausal group (38.33 vs. 71.25%; χ2 = 36.202, P < 0.001). The overall positive margin rate of cold-knife conization (25.83 vs 12.50%; χ2 = 10.106, P = 0.001) and rate of positive endocervical cone margins (16.67 vs. 4.58%; χ2 = 14.843, P < 0.001) were significantly higher in the post-menopausal group. Moreover, 49 post- and 60 pre-menopausal women underwent subsequent surgical treatment (40.83 vs. 25.00%). Residual rate of positive and negative margins in patients before and after menopause was significantly different (χ2 = 5.711, P = 0.017; χ2 = 12.726, P < 0.001, respectively). The recurrence rate in post-menopausal women remained 3.85%. Conclusions Cold-knife conization can be performed as a primary procedure for diagnosis and surgery of post-menopausal patients with high-grade squamous intraepithelial lesions. Sufficient deep excisions are necessary to avoid positive endocervical margins, which can reduce the residual and recurrence of postoperative lesions.

Analysis of the clinical characteristics and surgical methods of high-grade squamous intraepithelial lesions of the cervix in postmenopausal women: A retrospective case study

“…This suggests that the extent of colposcopic exposure and the condition of the squamocolumnar junction do not influence the results of postoperative pathological assessments. These findings align with those reported in Fan’s study, [ 25 ] which indicated that colposcopic manifestations do not significantly correlate with postoperative pathological outcomes in postmenopausal women. This lack of correlation is attributed to hormonal changes occurring during the postmenopausal period.…”

HPV conversion rates after LEEP, cold-knife conization, and laser and drug therapy: A 4-year follow-up study

“…Close follow-up is recommended for patients with glandular involvement, older age, large BMI to prevent recurrence and disease progression. [20,21] In our study, among the 10 laser-treated patients, one case with multiple high-risk HPV infections (types 16, 51, and 31) was hospitalized for radical cervical cancer surgery after 2 years of laser treatment, with TCT suggesting HSIL and cervical pathology biopsy suggesting cervical cancer.…”