Wang Xinmei, Xu Juan, Gao Yang, Qu Pengpeng
Clinical College of Central Gynecology and Obstetrics, Tianjin Medical University, Tianjin, 300070, China.
Department of Gynecological Oncology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, 300100, China.
BMC Womens Health. 2021 May 7;21(1):191. doi: 10.1186/s12905-021-01329-x.
20-25% of women with high-grade cervical intraepithelial neoplasias (HSIL) have residual lesions after conization. The state of the margin is generally considered to be a risk factor for recurrence or persistent lesions. Predictors of positive margins and residual lesions need to be identified. A design for postoperative management and avoidance of overtreatment needs to be provided, especially for women of child-bearing age.
This study was a retrospective analysis of 1309 women of child-bearing age with HSIL, who underwent cold knife conization (CKC). Age, gravidity, parity, human papillomavirus (HPV) species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and Cervical Intraepithelial Neoplasia (CIN) grade were analyzed. Among those with positive margins, 245 patients underwent secondary surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Risk factors for positive margins and residual lesions were assessed.
There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P > 0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P < 0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P < 0.02). Age > 35 years was also a risk factor for residual lesions (P < 0.03).
High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially women < 35 years.
20%至25%的高级别宫颈上皮内瘤变（HSIL）女性在锥切术后存在残留病变。切缘状态通常被认为是复发或持续性病变的危险因素。需要确定切缘阳性和残留病变的预测因素。需要提供术后管理设计并避免过度治疗，尤其是对于育龄女性。
本研究对1309例接受冷刀锥切术（CKC）的育龄HSIL女性进行了回顾性分析。分析了年龄、妊娠次数、产次、人乳头瘤病毒（HPV）类型、细胞学检查、转化区类型、宫颈管刮术（ECC）结果、象限累及情况、腺体累及情况以及宫颈上皮内瘤变（CIN）分级。在切缘阳性的患者中，245例患者在三个月内接受了二次手术，包括CKC、环形电切术和全子宫切除术。评估切缘阳性和残留病变的危险因素。
两组在年龄、妊娠次数、产次、腺体累及情况和CIN分级方面无显著差异（P>0.3）。HPV类型、细胞学检查、ECC结果和象限累及情况存在显著差异（P<0.002）。多因素分析显示，主要细胞学异常、高危HPV感染、III型转化区、ECC结果阳性和多象限累及是切缘阳性和残留病变的独立危险因素（P<0.02）。年龄>35岁也是残留病变的危险因素（P<0.03）。
应考虑生育情况对高危女性进行适当治疗。切缘阳性的患者应进行个体化管理。对于无生育要求的女性，手术可能是合适的。对于有生育要求或无危险因素但不愿接受后续手术的女性，尤其是年龄<35岁的女性，密切随访是必要的。
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