Clinical value of intraoperative residual cervical biopsy for risk stratification of high-grade squamous intraepithelial lesion
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Published on: June 14, 2019
Xinyan Zhang1, Lili Chen1, Qin Yu1
1Department of Obstetrics and Gynaecology, the 970th Hospital of the Joint Logistics Support Force, Yantai, Shandong, China.
Objective:
To evaluate whether simultaneous cervical stump biopsy during cold knife conization (CKC) improves residual lesion risk stratification in patients with cervical high-grade squamous intraepithelial lesion (HSIL), and to assess its clinical value for guiding postoperative management.
Methods:
This retrospective cohort study included 108 patients diagnosed with HSIL who underwent CKC between June 2022 and May 2024. All patients underwent CKC with simultaneous four‑quadrant and endocervical multipoint biopsy of the residual cervical stump. Residual lesion status, the correlation between margin status and residual disease, independent risk factors, and pathological downgrading rates were analyzed.
Results:
Residual lesions were detected on intraoperative residual cervical stump biopsy in 24 of 108 patients (22.2 %). The residual lesion rate was significantly higher in margin‑positive patients (18/30, 60.0 %) than in margin‑negative patients (6/78, 7.7 %; P < 0.001; OR 18.00, 95 % CI 6.78-47.79). No severe complications occurred. Multivariate logistic regression identified menopausal status (postmenopausal) (OR 3.41, 95 % CI 1.18-9.86, P = 0.024), HPV 16/18 infection (OR 4.12, 95 % CI 1.45-11.76, P = 0.008), and glandular involvement (OR 5.54, 95 % CI 1.94-15.85, P = 0.001) as independent risk factors for residual disease. Pathological downgrading occurred in 28 patients (25.9 %). Among downgraded patients, only 2 (7.1 %) had positive stump biopsy, both with high‑risk features.
Conclusion:
Simultaneous cervical stump biopsy during CKC is safe and identifies occult residual lesions, including 7.7 % of margin‑negative patients. Postmenopausal status, HPV 16/18, and glandular involvement are high‑risk factors. Our single‑center cohort findings provide preliminary, actionable evidence supporting its integration into routine clinical pathways for individualized postoperative management of HSIL; large‑scale multicenter prospective validation is required to confirm generalizable clinical utility.