Zhaoxia Ding

Risk factors associated with adverse outcomes after cervical conization in patients with cervical adenocarcinoma in situ

Background Identifying high-risk groups for adverse outcomes after conization is crucial for developing targeted treatment plans for patients with cervical adenocarcinoma in situ (ACIS). This study aimed to analyze the clinical characteristics of patients with ACIS and identify risk factors associated with adverse outcomes. Methods Patients diagnosed with ACIS through colposcopic biopsy at the Affiliated Hospital of Qingdao University and Qilu Hospital between January 2012 and December 2022 were selected. After meeting the inclusion and exclusion criteria, we collected their clinical data. Chi-square (χ2) tests and logistic regression models were employed to determine independent risk factors. Results A total of 379 patients with ACIS were included in this analysis. About 26.1% of these patients tested positive on preoperative endocervical curettage (ECC), while 79.4% had a single lesion. Among the 334 patients who underwent cervical conization, 17.1% had positive surgical margins. Additionally, residual lesions were present in 53.6% of cases, and pathological upgrading occurred in 7.8% of patients. Multivariate analysis indicated that age (p < 0.001), preoperative histopathological results from ECC (p = 0.033), and the number of ACIS lesions (p < 0.001) were associated with positive surgical margins. Number of births (p = 0.011), preoperative histopathological results from ECC (p = 0.030), and surgical margin statuses at cervical conization (p < 0.001) were independent risk factors for residual lesions. Preoperative histopathological result of ECC (p = 0.035) was confirmed as a predictor of postoperative pathological upgrading. Conclusions Older, multiparous patients with ACIS and abnormal preoperative ECC results require deeper diagnostic excision. Patients with positive conization margins necessitate further treatment, particularly when accompanied by abnormal ECC results. For women who wish to preserve their fertility, a repeat conization may be appropriate; however, in older and multiparous women, a hysterectomy would be recommended.

Factors associated with human papillomavirus persistence after loop electrosurgical excision procedure in patients with cervical squamous intraepithelial lesion

AbstractAimTo seek the high‐risk factors of human papillomavirus (HPV) persistence and residual lesion or recurrence after loop electrosurgical excision procedure (LEEP) focus on the predictive value of intraoperative human papilloma virus (IOP‐HPV) testing.MethodsIntraoperative endocervical sample was obtained with a cytobrush from the remained cervix of 292 patients immediately after LEEP. HPV Genotyping was performed using a polymerase chain reaction technique. All patients followed by HPV genotyping and cytology every 3–6 months. The IOP‐HPV testing results and possible risk factors such as age, cytology grade, menopause status, margin involvement, preoperative HPV status, and cervical lesion grade were assessed in predicting persistence of HPV and residual lesion or recurrence after surgery.ResultsThere were 61 (20.9%) patients presented persistent HPV infection. Multivariate analyses showed that IOP‐HPV positive, post‐menopause and preoperative HPV multiplex infection was strongly associated with HPV persistence after LEEP, IOP‐HPV positive and post‐menopause was also associated with residua or recurrent disease after LEEP.ConclusionsIOP‐HPV positive, post‐menopause, and preoperative HPV multiplex infection are independent predictors of HPV persistence in patients with cervical squamous intraepithelial lesion treated by LEEP. IOP‐HPV test is a new approach that may potentially allow for early identification of patients at high risk of HPV persistence and residua or recurrent disease after LEEP, thereby possibly facilitate an attenuated follow‐up schedule for negative patients those at low risk of persistent HPV infection.