Residual Lesions And The Related Factors In The High-level Cervical Intraepithelial Neoplasia Patients With Positive Margins In The Initial Conization

Backgroud and Purpose:At present, cervical conization (cold knife conization and LEEP surgery) is the preferred method of treatment for cervical intraepithelial neoplasia, but the next step in the treatment of patients with positive resection margin has no conclusion. The key point is that the possibility of residual disease in positive-margin patients. The purpose of this study was to explore the residual lesions in the high-level cervical intraepithelial neoplasia patients with positive resection margins in the initial conization and its related factors.Materials and methods:A retrospective collection of145patients’clinical data had been done from January1st2006to December31st2011at the Women’s Hospital of Zhejiang University. The patients need to fit the conditions below:the initial conization with positive margins and then did the second surgery in our hospital. We analyzed the residual lesions and their related factors.Results:The postoperative pathology results of the second operation suggest that there are47cases of cervical intraepithelial neoplasia and cervical cancer,98cases of chronic cervical mucosa inflammation, the residual disease rate is32.41%. age≥35-year-old、menopause status、LBC prompted ASC-H or HSIL preoperative HC2HR-HPV DNA load RLU/CO≥300and endocervical curettage prompts CIN are related with residual lesions. Secondary surgical pathology specimens ultimately results suggest that the6cases of invasive cervical cancer,2cases of cervical cancer Ial,3cases of cervical cancer Ia2and1case of cervical cancer II al. Menopausal status and the endocervical curettage material prompted CIN are related with invasive cancer. Multivariate logistic regression analysis showed that age, LBC prompted a high degree of intraepithelial lesions(ASC-H,HSIL) and HR-HPV DNA high-load are closely related with residual lesions. The relative risk were3.618,3.401,1.994; menopause prompt invasive cervical cancer in the second surgery, the relative risk of10.636. We followed up all the145cases to March2012, a total of three cases of recurrence, accounting for2.07%of the surgery patient.Conclusion:Age>35years, LBC prompt ASC-H and HSIL and HPV DNA load>300are independent risk factors associated with residual lesions in patients treated by second surgery. The patien’s memopausal status is the only independent risk fator for the high-grade CIN patient with initial positive resection margin who coexists invasive cervical cancer. If the non-menopausal patients with positive resection margin want to do hysterectomy, it’s better not to process by cervical cancer Ibl phase.