title: Risk factors for residual disease after cervical conization in patients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins.
abstract: OBJECTIVE
  To evaluate risk factors for the persistence of cervical intraepithelial neoplasia (CIN) grade ≥2 following repeat surgical procedures in patients with CIN grades 2 and 3 and positive surgical margins.
  
  
  METHODS
  This study included patients with CIN grades 2 and 3 and positive surgical margins following loop electrosurgical excision procedures (LEEP), who had undergone additional surgery between 2007 and 2014. Factors associated with CIN grade ≥2 on biopsy results after the second operation were assessed by multiple logistic regression analysis. Factors considered included patient age, parity, menopausal status, smoking, referral cytology, initial LEEP pathology, time interval between LEEP and surgical procedures, presence of disease on endocervical sampling, endocervical surgical margins, glands, disease surrounding ≥50% of the cervical circumference and requirement for multiple sweeps on initial LEEP to excise a lesion. The forward likelihood ratio method was used and significance was set at p<0.05.
  
  
  RESULTS
  Repeat surgical procedures were performed in 104 patients, 75 with CIN 2 and 29 with CIN 3, with 43 (41.3%) reported as normal or CIN 1. However, 57 (54.8%) patients had CIN ≥2 lesions and four (3.8%) had previously undiagnosed cervical cancer. Factors associated with CIN ≥2 lesions included requirement for multiple sweeps (vs. a single sweep; odds ratio [OR] 5.967; 95% confidence interval [CI] 2.183-16.311, p<0.001) and involvement of ≥50% of the cervical circumference (vs. <50%; OR 5.073; 95% CI 1.501-17.146, p=0.009).
  
  
  CONCLUSIONS
  As lesions requiring multiple sweeps for excision and/or surrounding ≥50% of the cervical circumference during initial conization are associated with recurrent CIN ≥2 lesions, attention should be paid during resection to prevent margin positivity. If surgical margins are positive, however, repeat surgical procedures should be considered in patients with CIN 2 and CIN 3 lesions and these risk factors.
authors.affiliation: Department of Gynecologic Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Ayhan
authors.affiliation: Department of Gynecologic Oncology, Baskent University Faculty of Medicine, Ankara, Turkey. Electronic address: aykuttuncer@hotmail.com.
authors.forename: Hasan Aykut
authors.initials: HA
authors.lastname: Tuncer
authors.affiliation: Department of Pathology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Nihan Haberal
authors.initials: NH
authors.lastname: Reyhan
authors.affiliation: Department of Gynecologic Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Esra
authors.initials: E
authors.lastname: Kuscu
authors.affiliation: Department of Gynecologic Oncology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Polat
authors.initials: P
authors.lastname: Dursun
mesh_terms: D000328:Adult; D019092:Conization; D005260:Female; D006801:Humans; D016015:Logistic Models; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery
keywords: Cervical cancer; Cervical intraepithelial neoplasia; Conization; Human papilloma virus (HPV); Loop electrosurgical excision procedure (LEEP); Margin