| [Objective]There is a definite precancerous lesion before the incidence of cervical cancer, so called cervical intraepithelial neoplasia. It has been proved that the detection and treatment of cervical intraepithelial neoplasia can effectively prevent the occurrence of invasive cervical cancer by screening. At present, cervical conization is the main method of the treatment of high grade CIN. Although the majority of patients can be cured, but there are a small number of patients with residual lesions/recurrence. Now Several studies have demonstrated incomplete excision after conization to be a significant predictor for either persistence or recurrence of cervical dysplasia during follow-up. Therefore, further studies on the risk factors and follow-up strategies of residual/recurrent disease in patients with positive margin after cervical conization have become the focus of attention. The purpose of this study was to explore prevalence of disease persistence and risk factors of residual or recurrent cervical disease in patients with postoperative positive margin after initial conization, and further explore the ideal strategy for postoperative follow-up.[Methods]We retrospectively reviewed the records for 134 women who underwent cervical conization for CIN between January 2010 and July 2014 at Women’s Hospital, School of Medicine, Zhejiang University, China. The median age of all patients was 42 years (range 21-69 years). The inclusion criteria were the initial conization with positive margins and did not have the second surgery with 6 months.We analyzed the follow-up data retrospectively,and studied the residual/recurrent incidence after primary cervical cone resection with positive margins and related risk factors.[Results]1. Among these 134 patients, evidence of residual/recurrent disease was found in the follow-up in 41 (30.6%) patients. Univariate analysis showed that grade of histology of conization magins, post-cone endocervical margin status were associated with residual or recurrent cervical disease. Hower, there were no significant differences in the incidence with age, gravidity, menopause status, parity, method of conization, cytology, histological diagnosis, endocervical curettage.Multivariate logistic regression analysis showed that endocervical margin involvement was the only significant independent risk fact for predicting residual/recurrent disease, OR= 5.481,95%CI=1.800-16.687.2. Follow-up procedures included liquid-based cytological testing and/or detection of high risk HPV DNA by HPV-HC II.We collected the data in 3 months,6 months,12 months,24 months after initial conization.We demonstrated that testing for high risk HPV DNA after conization was more sensitive than cytology for identifying women at high risk for residual/recurrent of CIN, and was not different from HPV/cervical cytology co-testing. In addition,we indicated the negative predictive value of high risk HPV DNA testing for residual/recurrent disease during follow-up was 97.4-100%.There suggested that high risk HPV DNA in 6 months after conization had the good diagnostic performance.[Conclusion]1. Endocervical margin involvement is the independent risk factors for residual/ recurrent disease, suggesting that this part of the patients should receive further treatment.2. HPV testing forecast the residual disease/recurrence after initial conization with positive margins in the follow-up was more accurate than TCT testing, and combined screening and HPV testing compared did not differ significantly.These findings support the hypothesis that HPV testing could be a stand-alone test in follow-up after conization.3. We indicated the negative predictive value of high risk HPV DNA testing for residual/recurrent disease during follow-up was high. HPV test negative patients with negative HPV testing had less chance of the detection of residual disease/ recurrence.The accuracy of HPV testing was better in 6 months after conization than in 3months, and had no significant difference in 12 and 24 months after operation, suggesting that patients with the positive HPV testing in 6 months after conization should be treated actively. |
