Residual cervical H-SIL after cervical conization with positive margins. Is there any associated risk factor?

Abstract

Introduction: Cervical cancer is the second leading cause of death from gynecological cancer. In Argentina, it is estimated that nearly 4,500 new cases are diagnosed each year and 1,800 women die from this disease. The human papillomavirus (HPV) is a necessary but not a major cause to develop this type of cancer and it is responsible for producing both low-grade (L-SIL) and high-grade (H-SIL) squamous intraepithelial lesions (SIL) depending on the viral serotype in addition to other factors specific to the infected patient. Cervical intraepithelial neoplasia (CIN) is treated by local ablation or excision techniques with lower morbidity. The choice of treatment depends on the degree and extent of the disease, as well as the patient age, risk factors and immunity to generate spontaneous regression or persistence/recurrence. Objective: To identify clinical or pathological factors in patients who presented residual lesion (H-SIL) in the surgical specimens of both re-conization and hysterectomy (HT). Materials and methods: A retrospective, observational study was carried out at Sanatorio Güemes, Buenos Aires, Argentina. All patients that underwent cervical conization with an electric scalpel and had positive margins in the surgical specimen between January 2017 and May 2022 inclusive were analyzed. Data was obtained from 43 patients who had positive cervical conization specimen margins at our institution in the time period described above. Two patients who only had the exocervical margin involved and also 11 patients who did not meet the inclusion criteria were excluded. Among patients (30), all were reoperated (16 underwent re-conization, while in 14 patients it was decided to have a total hysterectomy). Among all the patients who underwent a new surgical procedure, residual disease was found in 10 patients (33.3%), while 20 patients (66.6%) had no residual lesion. Results: The highest percentage of patients (66.6%) did not present residual lesions in the posterior resection specimens. The parameter exhibiting the most substantial influence in our analysis was the proportion of lesion extension, exerting a significant effect on the persistence/recurrence of the disease in subsequent surgical samples (Relative Risk [RR] 7.87, 95% Confidence Interval [CI] 1.13-54.66, p < 0.01). Conclusion: This information brings us even closer to the new reports of bibliographical data: although the presence of the compromised endocervical margin is valuable for estimating the risk of disease persistence/recurrence, it is not sufficient. Therefore, there is a lack of information about the importance of other factors to predict this situation.