Parameters Associated With Persistent Disease Afterexcisional Treatment by Electrosurgery in Patients With High Grade Cervical Intraepithelial Lesion and Positive Surgical Margin

Abstract

Purpose: In the treatment of high-grade cervical intraepithelial lesions (HSIL), when HSIL is detected at the surgical margin after excision, re-excision or control after 4-6 months are the management options. However, the parameters to determine in which patients HSIL will persist in the re-excision materials are not precisely defined. In this study, we aimed to evaluate the relationship between clinical and histopathological parameters, and the persistence of the lesion after electrosurgical excision. Materials and methods: The information of the patients who had HSIL at surgical margin after electrosurgical excisional treatment and were experienced re-excision for this reason were retrospectively investigated. In addition, the sociodemographic data of the patients, HPV (Human Papilloma Virus) typing (HPV type 16/18 or other high risk types) at the time of admission, maximal lesion diameter, number of foci, degree of high-grade lesion (CIN2 or CIN3), maximal diameter of excisional material, surgical margin status and grading (Grade 1: suspicious or relatively borderline surgical margin positivity; Grade 2: significant surgical margin positivity), and persistence of HSIL in the subsequent excisional procedure were recorded for analysis. Results: 73 patients who met the inclusion criteria of the study were identified. High-grade lesions were found to persist in 23 (31.5%) patients who underwent re-excision. When sociodemographic and histopathological factors were analyzed (age, menopause, smoking, initial high-risk HPV type, size of excision, histological type (CIN2/CIN3) lesion size, lesion focus number, and the degree of surgical margin positivity), no statistical significance was found between the groups with and without residual disease (p=0.116, p=0.750, p=0.601, p=0.092, p=0.719, p=0.501, p=0.699, p=0.131, p=0.884, respectively). Conclusions: HSIL is found to be persisted in approximately one third of the cases with positive surgical margin after re- excision. However, neither clinical features nor pathological findings at the first excision were found to be significantly related with persistence. © 2021, Pamukkale University. All rights reserved.