Zhang Lu, Shang Shuang, Quan Peiqing, Sui Long, Cong Qing
Obstetrics and Gynecology Hospital of Fudan University, Cervical Disease Center, Shanghai, China.
Obstetrics and Gynecology Hospital of Fudan University, Department of Operation Room, Shanghai, China.
Int J Gynecol Cancer. 2025 Jul;35(7):101825. doi: 10.1016/j.ijgc.2025.101825. Epub 2025 Apr 11.
To determine the association between cone length and internal margin positivity in high-grade squamous intraepithelial lesion (HSIL) patients, stratified by age, and provide personalized treatment recommendations.
We conducted a retrospective analysis of 1188 HSIL patients treated with Loop Electrosurgical Excision Procedure at the Obstetrics and Gynecology Hospital of Fudan University in 2021. The study evaluated human papillomavirus genotyping, cytology, colposcopy findings, and characteristics of cone excision. Logistic regression analysis was performed to identify independent risk factors associated with internal margin positivity.
The overall rate of positive internal margins was 11%. Age (OR 1.03, 95% CI 1.00 to 1.05, p = .021), high-risk cytology (OR 1.69, 95% CI 1.12 to 2.52, p = .012), human papillomavirus 16 infection (OR 1.78, 95% CI 1.18 to 2.66, p = .006), and endocervical HSIL lesion (OR 5.05, 95% CI 3.15 to 8.08, p < .001) were independent risk factors for internal margin positivity. Notably, among women >50, a negative correlation between cone length and positive internal margins was observed. A cone length exceeding 20 mm reduced the positive internal margin rate to 7%. In cases of cervical atrophy, excising at least 50% of the pre-operative cervical length significantly reduced the positive internal margin rate to 12.5%.
The length of the excision cone is a significant risk factor for positive internal margin, particularly among women >50. This highlights the importance of age-specific, optimized cervical excision lengths and supports personalized treatment strategies.
确定高级别鳞状上皮内病变（HSIL）患者中锥切长度与切缘阳性之间的关联，并按年龄分层，提供个性化治疗建议。
我们对2021年在复旦大学附属妇产科医院接受环形电切术治疗的1188例HSIL患者进行了回顾性分析。该研究评估了人乳头瘤病毒基因分型、细胞学、阴道镜检查结果以及锥切的特征。进行逻辑回归分析以确定与切缘阳性相关的独立危险因素。
切缘阳性的总体发生率为11%。年龄（比值比1.03，95%置信区间1.00至1.05，p = 0.021）、高危细胞学（比值比1.69，95%置信区间1.12至2.52，p = 0.012）、人乳头瘤病毒16感染（比值比1.78，95%置信区间1.18至2.66，p = 0.006）以及宫颈管HSIL病变（比值比5.05，95%置信区间3.15至8.08，p < 0.001）是切缘阳性的独立危险因素。值得注意的是，在50岁以上的女性中，观察到锥切长度与切缘阳性之间呈负相关。锥切长度超过20毫米可将切缘阳性率降至7%。在宫颈萎缩的情况下，切除术前宫颈长度的至少50%可将切缘阳性率显著降至12.5%。
锥切长度是切缘阳性的一个重要危险因素，尤其是在50岁以上的女性中。这凸显了特定年龄、优化宫颈切除长度的重要性，并支持个性化治疗策略。
