Impact Of Cone Size Upon Persistent Or Recurrent High-grade Cervical Intraepithelial Neoplasia Following Conization

Objective:To investigate the risk factors of persistent or recurrent high-grade cervical intraepithelial neoplasia(hgCIN)after conization in order to propose a reasonable cone size and postoperative follow-up plan.Methods:Clinical data of 113 patients who received cervical conization for hgCIN in our department between August 2013 and June 2016 were collected and reviewed retrospectively.The correlation of clinicopathological parameters and postoperative recurrence was analyzed.The median follow-up time was 19 months(ranging from 2 to 39 months).Results:Recurrence occurred in 9 patients during the follow-up period.Multivariate analysis showed specimen thickness(cone width)was closely associated with CIN persistence/recurrence(HR:7.094,95%CI:1.350?37.279,P=0.021).With the cone width less than 1.77 cm,the area under the receiver operating characteristic(ROC)curve(AUC)was 0.81(95%CI:0.650?0.971),with sensitivity and specificity of 88.9%and 83.8%,respectively.With the cone depth less than 2.24 cm,the AUC of ROC curve was 0.689(95%CI:0.492?0.886),with sensitivity and specificity of 44.4%and 87.9%,respectively.Additionally,high risk HPV infection(HR:8.674,95%CI:1.047?71.862),and vaginal delivery>2 times(HR:10.708,95%CI:1.543?74.322)were predictive factors for CIN recurrence.Conclusion:Conization with enough width and depth is pivotal to prevent recurrence or persistence in patients with hgCIN who chose conization for treatment.For those with high risk HPV infection,multiple vaginal delivery,small conization(cone width<1.77 cm,cone depth<2.24 cm),close follow-up is recommended,including cervical cytology,HPV genotyping and colposcopy.