Abstract
Objective: To evaluate the presence of residual preinvasive or invasive cervical disease after re-conization or hysterectomy in women with positive surgical margins following excisional treatment for high-grade squamous intraepithelial lesions (HSIL), and to identify pathological factors that may be related to residual disease.
Material and Methods: This retrospective cohort included 48 women with positive ectocervical margins, endocervical margins, or endocervical curettage (ECC) margins after initial excisional procedures (cold-knife conization, loop electrosurgical excision procedure, or needle excision of the transformation zone). All patients underwent either re-conization or hysterectomy. Cone volume was calculated using the semi-ellipsoid formula (π/6 × anteroposterior × transverse × length). Categorical variables, including margin type, ECC results, human papillomavirus status, and excisional technique, were compared using the chi-square test or Fisher’s exact test.
Results: Residual HSIL or carcinoma was identified in 45.9% of patients undergoing repeat excision, whereas 54.1% had only low-grade intraepithelial lesions or no preinvasive lesion. Ectocervical margin positivity showed limited predictive value for residual high-grade pathology. Endocervical margin positivity and ECC positivity demonstrated similar distributions, with residual HSIL or carcinoma present in approximately half of these patients. Residual pathology occurred following both cold-knife conization and electrosurgical excisional techniques. Residual disease occurred more frequently after cold-knife conization than after electrosurgical techniques; however, this difference was not statistically significant (p=0.051).
Conclusion: Residual high-grade disease was detected in nearly half of the patients undergoing repeat surgery after a margin-positive conization. Although certain variables such as excisional technique and endocervical margin involvement showed numerical differences, none reached statistical significance. These findings suggest that no single clinical or pathological factor reliably predicts residual disease, and margin status alone may be insufficient to guide management decisions.