Risk Factors for Residual Disease in Hysterectomy Specimens After Conization in Post-Menopausal Patients with Cervical Intraepithelial Neoplasia Grade 3

Figures & data

Figure 1 Flow chart of post-menopausal patients underwent hysterectomy for cervical intraepithelial neoplasia grade 3 in the study.

Abbreviations: LEEP, loop electrosurgical excision procedure; CKC, cold knife conization; CIN, cervical intraepithelial neoplasia.

Table 1 General Characteristics of 129 Patients

Parameters	Values
Age, y, mean (range)	54 (44–69)
Parity, median (range)	2 (1–5)
Smoking status, n (%)
Smoker	0 (0)
Non-smoker	129 (100)
TCT, n (%)
NILM	1 (0.78)
ASCUS	27 (20.93)
LSIL	8 (6.20)
ASU-H	13 (10.08)
HSIL	55 (42.64)
AGC	2 (1.55)
Unknown	23 (17.83)
HPV status, n (%)
HR-HPV positive	101 (78.29)
Multiple HR-HPV positive	30 (23.26)
Single HR-HPV positive	34 (26.36)
HPV 16 positive	50 (38.76)
LR-HPV positive	1 (0.78)
Negative	4 (3.10)
Unknown	23 (17.83)
Colposcopic biopsy, n (%)
CIN1	6 (4.65)
CIN2	33 (25.58)
CIN3	86 (66.67)
Unknown	4 (3.10)
Pre-cone ECC, n (%)
Normal	29 (22.48)
Abnormal	53 (41.09)
Unknown	47 (36.43)
Operating surgeon, n (%)
Junior	80 (62.02)
Senior	49 (37.98)
Conization method, n (%)
LEEP	22 (17.05)
CKC	107 (82.95)
Cone volume, cm^3, median (25th-75th percentiles)	1.57 (0.91,2.62)
Glandular involvement, n (%)
Negative	9 (6.98)
Positive	120 (93.02)
Margin status, n(%)
Negative	83 (64.34)
Positive	46 (35.66)
Residual lesion, n(%)
None	66 (51.16)
CIN1	7 (5.43)
CIN2	4 (3.10)
CIN3	48 (37.21)
Invasive Cancer	4 (3.10)

Abbreviations: TCT, Thinprep cytology test; NILM, negative for intraepithelial lesion or malignancy; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; ASC-H, atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion; AGC, atypical glandular cells; HR-HPV, high-risk human papilloma virus; LR-HPV, low-risk human papilloma virus; CIN, cervical intraepithelial neoplasia; ECC, endocervical curettage; LEEP, loop electrosurgical excision procedure; CKC, cold knife conization.

Table 2 Univariate Analysis on Factors Correlated with Residual Lesions in Hysterectomy Specimens

Parameters		Residual Rate		P
		≤CIN1	≥CIN2
Age, y	Median	53	55.5	0.181
	IQR	9	9.75
	≤ 60	60(57.14)	45(42.86)	0.791
	> 60	13(54.17)	11(45.83)
Parity, n	Median	2	2.5	0.203
	IQR	1	1.75
	≤ 2	44(61.11)	28(38.89)	0.244
	> 2	29(50.88)	28(49.12)
Pre-cone cytology	≤ LSIL	20(55.56)	16(44.44)	0.901
	≥ ASC-H	38(54.29)	32(45.71)
HPV status	Multiple infection	16(53.33)	14(46.67)	0.762
	Single or non infection	43(56.58)	33(43.42)
	16 genotype	28(56.00)	22(44.00)	0.947
	Non-16 genotype infection	31(55.36)	25(44.64)
Colposcopy biopsy	≤ CIN2	28(71.79)	11(28.21)	0.012
	> CIN2	41(47.67)	45(52.33)
Pre-cone ECC result	Normal	22(75.86)	7(24.14)	0.001
	Abnormal	22(41.51)	31(58.49)
Operating surgeon	Junior	47(58.75)	33(41.25)	0.527
	Senior	26(53.06)	23(46.94)
Conization method	LEEP	54(50.47)	53(49.53)	0.002
	CKC	19(86.36)	3(13.64)
Cone volume, cm^3	Median	1.88	1.11	0.002
	IQR	2.09	1.31
	≤ 1.57	34(47.22)	38(52.78)	0.016
	> 1.57	39(68.42)	18(31.58)
Glandular involvement	Positive	68(56.67)	52(43.33)	0.948
	Negative	5(55.56)	4(44.44)
Margin status	Positive	20(43.48)	26(56.52)	0.025
	Negative	53(63.86)	30(36.14)

Note: Bold values indicate P < 0.05.

Table 3 Characteristics of Patients with Residual Invasive Cervical Cancer

	Age, y	G/P, n	TCT	HPV	Biopsy	Pre-Cone ECC	Cone Method	Cone Pathology	Margin	FIGO Stage (2009)	Supplemental Therapy	Follow-Up Time, Month	Recurrence
Case 1	59	6/5	HSIL	16	CIN3	Positive	LEEP	CIN3	Positive	ⅠA2	Chemotherapy	71	No
Case 2	51	5/2	ASCUS	Unknown	CIN3	Negative	LEEP	CIN3	Negative	ⅠA1	None	81	No
Case 3	60	4/4	ASC-H	16, 33	CIN3	Positive	LEEP	CIN3	Positive	Ⅰb1	Chemotherapy + radiotherapy	34	No
Case 4	48	5/5	HSIL	Unknown	CIN3	Negative	LEEP	CIN3	Positive	ⅠA1	None	34	No

Abbreviations: G/P, gravidity/parity; CIS, carcinoma in situ; FIGO, Federation International of Gynecology and Obstetrics.

Table 4 Multivariate Analysis on Factors Correlated with Residual Lesions in Hysterectomy Specimens

Parameters		OR	95% CI	P
Colposcopy biopsy	≤ CIN2	Ref
	> CIN2	2.34	0.84–6.53	0.104
Pre-cone ECC result	Normal	Ref
	Abnormal	3.99	1.41–11.33	0.009
Cone volume, cm^3	≤ 1.57	Ref
	> 1.57	0.57	0.21–1.54	0.266
Margin status	Negative	Ref
	Positive	1.64	0.59–4.60	0.344

Note: Bold value indicates P < 0.05.