Risk Factors for Persistence or Recurrence of High-Grade Cervical Squamous Intraepithelial Lesions

Area of Science:

• Gynecology
• Oncology
• Pathology

Background:

• Cervical intraepithelial neoplasia (CIN) 2/3 requires treatment to prevent progression to invasive cervical cancer.
• Conization procedures, including cold knife conization (CKC) and loop electrosurgical excision (LEEP), are standard treatments.
• Identifying risk factors for treatment failure is crucial for patient management.

Purpose of the Study:

• To determine if colposcopic lesion size, patient age, surgical method, margin status, or p16/Ki-67 expression predict CIN persistence or recurrence.
• To identify independent risk factors for treatment failure following conization for CIN 2/3.

Main Methods:

• A retrospective, observational study analyzed data from 271 patients with CIN 2/3 treated with CKC or LEEP.
• Variables assessed included colposcopic lesion size, age, surgical technique, surgical margin status, and p16/Ki-67 immunomarker expression.
• Logistic regression was used to evaluate associations with lesion persistence or recurrence.

Main Results:

• Of 264 patients followed, 38 experienced persistent or recurrent CIN.
• Positive endocervical margins were identified as the only independent risk factor for recurrence (p<0.001).
• No significant associations were found for lesion size, age, surgical type, or p16/Ki-67 status.

Conclusions:

• Positive endocervical margins are a critical predictor of CIN persistence or recurrence after conization.
• Routine assessment of surgical margins, particularly the endocervical margin, is essential.
• Factors such as lesion size, age, and immunomarker status do not appear to influence treatment outcomes in this cohort.