Outcome after loop electrosurgical excision procedure for cervical high-grade squamous intraepithelial lesion.

Area of Science:

• Gynecology
• Oncology
• Pathology

Background:

• Cervical high-grade squamous intraepithelial lesion (HSIL) treatment aims to prevent cervical cancer while preserving reproductive function.
• Management of positive margins after excisional treatment for HSIL remains a clinical challenge.
• Predicting residual/recurrent HSIL and guiding treatment decisions are critical.

Purpose of the Study:

• To identify clinical and histologic predictors of residual/recurrent HSIL after excisional treatment.
• To evaluate the outcomes for women with positive margins following HSIL excision.
• To inform optimal management strategies for positive margins in HSIL treatment.

Main Methods:

• Retrospective cohort study involving 386 women treated for HSIL between January 2012 and December 2015.
• Analysis of margin status (positive vs. negative) after excisional treatment.
• Assessment of cumulative rates of residual/recurrent HSIL, subsequent abnormal cervical smears, and need for further procedures.

Main Results:

• Positive margins were observed in 40.2% of women, while 54.9% had negative margins.
• The cumulative rate of residual/recurrent HSIL was significantly higher in the positive margin group (15.7% at 2 years, 16.8% at 5 years) compared to the negative margin group (1.8% at 2 years, 5.0% at 5 years).
• Positive margins were associated with increased rates of subsequent abnormal cervical smears, colposcopy referrals, and further SIL treatment.

Conclusions:

• A majority (85%) of women with positive margins did not develop residual/recurrent HSIL, suggesting close surveillance with cytology is a reasonable approach.
• Repeat excision may be considered for selected patients with positive margins, particularly those with endocervical glandular involvement, older age, or difficulty with follow-up.
• The study highlights the importance of individualized management strategies for positive margins after HSIL treatment.