To explore treatment strategy for patients with positive margins after cervical cold knife conization (CKC) by estimating the risk of residual or recurrent CIN2 or worse (CIN2+).
A retrospective study included 569 patients receiving CKC for CIN3 in Xiangya Hospital from January 2013 to December 2017. Demographic characteristics and test results were obtained prior to CKC, post CKC at 6,12,24 months and annually thereafter. The primary endpoint was residual/recurrent CIN2+ post-CKC.
14 (2.46%) patients had residual/recurrent CIN2+ with a median time of occurrence at 12 months post-CKC. Taking the average age and HC2 value as thresholds, the risk of residual/recurrent CIN2+ was higher in women aged over 40 years or with a baseline HC2 ≥300 RLU/PC. Patients with positive margins were at higher risk of residual/recurrent CIN2+ (HR: 3.66, 95%CI:1.25-10.71), especially when endocervix was involved. 536 (94.20%) patients received HPV testing within 6 months post-CKC. Patients with both positive HPV testing results and positive margins were at the highest risk of residual/recurrent CIN2+.
Patients with positive endocervical margins are at high risk for residual/recurrent CIN2+, independent of the severity of margins. HPV testing within 6 months post-CKC may be a feasible triage strategy for these patients.
Fu K, Lei M, Yang WQ, Wu LS, Shi JC, Zhang Y. (2021). The treatment strategy of patients with positive margins after cervical cold knife conization --a 7-year retrospective study in China. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics