Necessity for subsequent surgery in women of child-bearing age with positive margins after cold knife conization: A retrospective cohort study

Abstract Background: Risk factors for positive margins and residual lesions after cold knife conization (CKC) for high-grade cervical intraepithelial neoplasias (CIN) were assessed in women of child-bearing age. A design for postoperative management and avoiding these situations is offered.Methods: This was a retrospective study on 1,309 premenopausal women with high-grade CIN (including CIN3 and CIN2) based on a cervical biopsy under colposcopy used to diagnose a positive or negative margin. Age, gravidity, parity, HPV species, cytology, transformation zone type, results of endocervical curettage (ECC), quadrant involvement, glandular involvement, and CIN grade were analyzed. Among those with positive margins, 245 underwent surgery within three months, including CKC, a loop electrosurgical excision procedure, and total hysterectomy. Residual lesions were also assessed.Results: There was no significant difference in age, gravidity, parity, glandular involvement, and CIN grade between the two groups (P>0.3). There was a significant difference in HPV species, cytology, ECC results, and quadrant involvement (P<0.002). Multivariate analysis showed a major cytology abnormality, high-risk HPV infection, type III transformation zone, positive ECC result, and multiple quadrant involvement were independent risk factors for positive margins and residual lesions (P35 years was also a risk factor (P<0.03).Conclusion: High-risk women should be treated appropriately considering fertility. Patients with positive margins should be managed uniquely. Surgery for women without fertility may be appropriate. Close follow-up is necessary for women who have fertility requirements or are unwilling to undergo subsequent surgery if they have no risk factors, especially for women <35 years.