Independent Predictive Factors for Positive Margins after Conization of Cervical HSIL in Women of Childbearing Age and the Necessity of Secondary Surgery
DOI:
https://doi.org/10.71222/veqxbw68Keywords:
women of childbearing age, cervical high-grade squamous intraepithelial lesion, loop electrosurgical excision procedure, positive margin, predictive factors, secondary surgeryAbstract
This study aims to analyze the high-risk factors for positive surgical margins after loop electrosurgical excision procedure (LEEP) and the necessity of secondary surgery in women of childbearing age (20-40 years) with high-grade squamous intraepithelial lesions (HSIL). Through retrospective analysis of 526 HSIL patients who underwent LEEP at the Third Affiliated Hospital of Sun Yat-sen University from 2015 to 2019, the positive margin rate was found to be 22.43%. Multivariate analysis indicated that TCT result of HSIL (OR = 3.414, 95%CI = 1.793-6.500, P < 0.001) and lesions involving ≥5 points (OR = 8.567, 95%CI = 4.439-16.533, P < 0.001) were independent risk factors for positive margins. Among 34 patients who underwent secondary surgery within six months after initial conization, 32 had positive margins, and the residual disease rate among them was only 21.88% (7/32), indicating that positive margins do not necessarily lead to residual lesions. Therefore, the decision for secondary surgery in patients with positive margins should be individualized based on factors such as age, fertility needs, lesion characteristics, complications, and personal preferences, rather than reflexively performing secondary surgery.
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