Chen Dandan, Wu Huamin, Huang Feifeng, Tan Kailiang
Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
PLoS One. 2025 Sep 12;20(9):e0331184. doi: 10.1371/journal.pone.0331184. eCollection 2025.
This study explored the prognosis of high-grade squamous intraepithelial lesion (HSIL) patients with negative margins, investigating the impact of different distances between lesions and incisal margins in conization specimens.
This retrospective cohort study included 240 HSIL patients. Patients with negative incisal margins were divided into 3 groups according to the distance between the lesion and the incisal margin in the conization tissue. Group 1 consisted of a distance of <1 mm (n = 23), Group 2 of 1-3 mm (n = 15), and Group 3 of >3 mm (n = 202). For patients with lesions close to the incisal margin (≤3 cm), the decision between total hysterectomy and clinical observation was made based on patient preference following detailed counseling of disease characteristics and prognosis. Thinprep cytologic test (TCT) and HPV testing were performed during follow-up at 6 and 12 months after the operation.
No significant difference in HPV and TCT positive rate was observed among the three groups at 6 months and 12 months after the operation (P = 0.561, 0.561 and P = 0.324, 0.268). In the group with a distance shorter than 3 mm, no difference in HPV positive rate was found between the total hysterectomy and observation groups (P = 0.480, 0.737). Additionally, no difference in HPV positive rate was observed between patients who underwent total hysterectomy compared to clinical observation in groups 1 and 2 (P = 0.565, 0.692; P = 0.758, 0.593). Stratified analysis revealed that HPV positive rates at 6 months and 12 months had no statistical significance with any factor.
Different distances between conization tissue lesions and incisal edges have no direct impact on the prognosis of HSIL patients with negative conization biopsy tissues; excessive hysterectomy is not recommended in patients (≤3 mm) close to incisal edges.
本研究探讨切缘阴性的高级别鳞状上皮内病变（HSIL）患者的预后，研究锥形切除标本中病变与切缘之间不同距离的影响。
这项回顾性队列研究纳入了240例HSIL患者。切缘阴性的患者根据锥形切除组织中病变与切缘之间的距离分为3组。第1组距离<1毫米（n = 23），第2组距离为1 - 3毫米（n = 15），第3组距离>3毫米（n = 202）。对于病变靠近切缘（≤3厘米）的患者，在详细咨询疾病特征和预后后，根据患者偏好决定是进行全子宫切除术还是临床观察。术后6个月和12个月随访时进行薄层液基细胞学检测（TCT）和HPV检测。
术后6个月和12个月，三组之间的HPV和TCT阳性率无显著差异（P = 0.561、0.561以及P = 0.324、0.268）。在距离短于3毫米的组中，全子宫切除术组和观察组之间的HPV阳性率无差异（P = 0.480、0.737）。此外，在第1组和第2组中，接受全子宫切除术的患者与临床观察组之间的HPV阳性率也无差异（P = 0.565、0.692；P = 0.758、0.593）。分层分析显示，6个月和12个月时的HPV阳性率与任何因素均无统计学意义。
锥形切除组织病变与切缘之间的不同距离对锥形切除活检组织阴性的HSIL患者的预后无直接影响；对于靠近切缘（≤3毫米）的患者，不建议过度进行子宫切除术。
