[Clinical management of patients with positive excision margin after cervical conization: analysis of 148 cases]

To explore the situation of residual lesions in excision margin after loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC) and the risk factors of recurrence in the cases featuring with positive margin.

The medical records of 1213 women undergoing LEEP or CKC, aged (35 +/- 5) (22-40), were retrospectively reviewed. 148 of the 1213 patients (12.2%) who were identified as with positive margin were re-underwent pathological reexamination. 118 of the 148 patients were diagnosed as with cervical intraepithelial neoplasia III (CIN III) and 30 as with stage Ia invasive cervical carcinoma. These patients were followed up for 12-99 months. The pathologic diagnoses, position of positive margin, and residual lesion in subsequent specimens were analyzed.

Endocervical positive margins were identified in 30 of the 118 (25.4%) CIN III patients and 26 of the 30 (86.6%) stage Ia patients. Residual lesions were found in 15 of the 28 (53.6%) stage Ia cases and 4 pf the 19 (19%) CIN III cases. The rates of endocervical positive margin and residual lesion were higher in stage Ia patients. The risk of residual lesion was 53.1% (17/32) in the patients with endocervical positive margins, significantly higher than that of the patients with extracervical positive margin (16.7%). Recurrence was found in 90 patients during follow-up.

Residual lesions often occur in some patients with positive margin. Choice between additional surgery and closely follow-up in the young patients with positive margins who want to preserve their fertility depends on the lesion seriousness and positive position. Residual lesions more frequently exist in the patients with microinvasion and endocervical positivity. Additional surgery should be considered in these cases.