Clinical outcome and high risk factor for residual lesion analysis of HSIL half a year after loop electrosurgical excision procedure: a clinical study of 1 502 cases

Abstract

Objective: To analyze clinical outcome of high-grade squamous intraepithelial lesion (HSIL) half a year after loop electrosurgical excision procedure (LEEP) and explore the high risk factor of residual cervical HSIL. Methods: The retrospective study was carried out on 1 502 patients who underwent LEEP, with HSIL in the LEEP histopathology from January 2011 to December 2013 at Obstetrics and Gynecology Hospital of Fudan University to confer the difference between residual group and non-residual group after 6 months of the leep conization. Patients were followed with ThinPrep cytologic test (TCT), high risk HPV (HR-HPV) test, colposcopy guided biopsy (CBD) and endocervical curettage (ECC). The high risks of residual cervical HSIL was analyzed. Results: Among 1 502 cases, 48 (3.20%, 48/1 502) cases suffered HSIL residual disease. Forty cases were diagnosed by CBD, 4 cases were diagnosed by ECC. The other 4 cases were both positive in CBD and ECC. Residul rate were different among different age groups. The residual rate was higher in the age ≥50 years old compared to the age below 50 [9.70% (16/165), 2.39% (32/1 337); χ(2)=25.33, P<0.01]. For post-LEEP specimens, both circumference (2.5, 2.8 cm; Z=-3.17, P<0.01) and width [0.6, 0.6 cm; Z=-2.88, P<0.01) were less in HSIL lesion residual group than those in non-residual group, though length showed no obvious difference [1.5, 1.5 cm; Z=-1.55, P>0.05) . The residual rate of leep positive margin was obviously higher than that in the negative margin group [6.77% (18/266) vs 2.43% (30/1 236) ; χ(2)=13.30, P<0.01]. Different positive margin had diverse residual rate, as positive endocervical margin was 16.07% (9/56), positive margin undetermined was 7.29%(7/96) and positive ectocervical margin was 3.33%(4/120). Both positive endocervical margin and positive margin undetermined had a higher residual rate than residual rate (χ(2)=26.99, P<0.01; χ(2)=4.24, P<0.05). Abnormal cytology showed higher residual rate than the non-residual with significant difference [6.00% (6/100) vs 1.29% (14/1 083) , χ(2)=9.50, P<0.01]. In terms of the post-LEEP HR-HPV test follow-up, HR-HPV positive's residual rate was higher than that in the negative group [2.91% (6/206) vs 0.96% (7/727)], while there was no statistical significance (χ(2)=3.10, P>0.05). Multivariate logistic analysis showed that abnormal cytology in 6 month's follow-up post-LEEP conization was an independent risk factor on residual lesion (OR=3.75, P<0.05). Conclusions: Patient with age ≥50 years old and positive endocervical margin are high risk factors for the residual HSIL lesion after LEEP conization,especially for abnormal cytology during follow up is independent risk factor for residual lesion. Colposcopy directed biopsy and (or) ECC still play an indispendsable role in finding the HSIL residual lesion.