The impact of individualized design of cervical LEEP surgery on endocervical margin status and disease prognosis

The impact of individualized design of cervical LEEP surgery on endocervical margin status and disease prognosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The impact of individualized design of cervical LEEP surgery on endocervical margin status and disease prognosis Tingyan Liu, Weijia Wang, Huiming Liao, Yun Zhao, Bi Mai, Guiying Hu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3973268/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Aim This study aimed to explore the relationship between individualized design of cervical loop electrosurgical excision procedure (LEEP ) and endocervical margin status as well as prognosis of cervical lesions. Methods A total of 151 outpatients dignosed with cervical high-grade squamous intraepithelial lesion(HSIL)in Guangdong Women and Children Hospital from January 2015 to December 2019 were included in this study. From the perspective of a patient's fertility requirments, the colposcopist conducted individualized LEEP with them. The pathologic features of the endocervical margins, presence of cervical stenosis or adhesion, and HPV test results within 2 years after the surgery were documented. Results 1.Endocervical margin positive rate of LEEP is13.25%(20/151). There were significant differences observed in design of LEEP between the patients with different reproductive requirements, although no statistically difference was detected in endocervical margin positivity rates (P = 0.979)with them.2.Univariate logistic regression analysis revealed that cervical cytology (P = 0.040), the number of quadrants involved by acetowhite epithelium (P = 0.032), and lesion grade of biopsy (P = 0.028) were significantly associated with endocervical margin .Multivariate logistic regression analysis revealed that quadrants involved by acetowhite epithelium (P = 0.034) and the grade of biopsy(P = 0.020)were independent risk factors for positive endocervical margin. 3.HPV clearance rate is 84.77% in 2 years after surgery.There are no significant differences with different endocervical margin status and HPV recheck results (≤ 6 months, 7–12 months, and 12-24months) (P = 1.000, 0.984, 0.382);4.Approximately 58.9%, 80.1%, and 86.8% of lesions can be removed with cone lengths ≤ 1cm,≤1.5cm, and ≤ 2.0cm, respectively. Conclusion Individualized LEEP surgical design is feasible and effective in clinical practice.Women with fertility requirements will benefit even more. high-grade squamous intraepithelial lesion human papillomavirus LEEP endocervical margin transformation zone Introduction Early detection of precancerous lesions of the cervix and selecting appropriate treatment methods is an important measure for preventing cervical cancer.At present, the preferred treatment for high-grade squamous intraepithelial lesion (HSIL) of the cervix is cervical conization .The loop electrosurgical excision procedure (LEEP) is the most commonly used, convenient, safe, and effective surgical method [1] .While the cervical LEEP procedure itself is relatively simple, achieving satisfactory outcomes requires precise surgical design. This is especially important for older women with fertility requirements, as excessive treatment may lead to adverse pregnancy outcomes, while insufficient treatment can increase the risk of repeat treatments. Therefore, the main focus of this study is to explore how to individualize the surgical design of LEEP procedure based on comprehensive colposcopy assessment to achieve optimal disease prognosis. Material and methods Participants: This study collected data from 151 patients who underwent cervical LEEP surgery for HSIL at Guangdong Women and Children Hospital outpatient clinic between January 2015 and December 2019. The mean age of the patients was 35.54 ± 7.298 years, with an average age of 39.87 ± 7.038 years for patients without fertility requirements and an average age of 30.50 ± 4.115 years for patients with fertility requirements. The study primarily collected the following patient information: age, fertility desire, menstrual status, preoperative cervical cytology and HPV typing, type of transformation zone (TZ) and number of quadrants involved by acetowhite epithelium under colposcopy, cervical pathology results of biopsy (including presence of glandular involvement), and preoperative pathology results of endocervical curettage (ECC),surgical approach and endocervical margins status. We review the further details on the clinicopathologic characteristics of the patients,(Table 1 ). Table 1 Baseline of clinicopathologic characteristics Total （ N=151 ） n （ % ） Menopause: No Yes 146 96.7 5 3.3 Fertility requirements : No Yes 91 60 60.3 39.7 HPV status before surgery: Non-16/18 hr-HPV positive HPV 16/18 positive 90 61 59.6 40.4 TCT: NILM ASC-US/LSIL ASC-H/HSIL/AGC/SCC 35 69 23.2 45.7 47 31.1 Cervical pathology results of biopsy: HSIL(CIN2) HSIL(CIN2-3、CIN3) 88 63 58.3 41.7 TZ types ： TZ1 TZ2 TZ3 11 7.3 14 9.3 126 83.4 Number of quadrants involved by acetowhite epithelium: 1 2 3 4 25 54 16.6 35.8 22 14.6 50 33.1 Cervical Intraepithelial Neoplasia Glandular Involvement: No Yes 97 54 64.2 35.8 ECC: No Yes Unknown 57 37.7 49 32.5 45 29.8 Surgical approach: LEEP top-hat LEEP 124 82.1 27 17.9 Status of endocervical margins: Negative positive 131 20 86.8 13.2 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 which did not exclude high-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion; hr-HPV, high-risk human papillomavirus; TZ, transformation zone; ECC, endocervical curettage; Design and setting All patients were screened using cervical liquid-based cytology combined with HPV typing. Patients with abnormal screening results were referred for colposcopy. Multiple biopsies were taken to confirm the diagnosis. For patients with pathologically proven HSIL, the colposcopist conducted individualized LEEP surgical design from the perspective of a patient's fertility requirments, based on the comprehensive and accurate colposcopic assessment of the TZ type, the extent of acetowhite epithelium (number of quadrants involved), as well as preoperative cervical cytology and cervical biopsy pathology results.After the surgery, specimen length, thickness, and surgical approach were measured and recorded in detail. Post-operatively, pathological results and endocervical margin status were monitored.All patients signed an informed consent form before the operation, and a follow-up plan was formulated after the pathological results were reported, with the signing of a postoperative follow-up informed consent form. Follow-up tests were conducted using cervical liquid-based cytology combined with HPV testing. The presence of cervical adhesions or stenosis at the external os after surgery was documented, and HPV test results were collected within 6 months, from 7–12 months, and 12–24 months after surgery. HPV testing This study used a 21-type HPV gene microarray typing kit produced by Guangdong Kepu Biotechnology Co., Ltd., which was approved by the China National Medical Products Administration. The HPV types detected included 13 high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), 5 low-risk types (6, 11, 42, 43, 44), and 3 other subtypes (53, 66, CP8304). Cervical liquid-based cytology Our hospital used the ThinPrep liquid-based cytology examination (TCT liquid-based cell preparation instrument produced by Beijing Yingshuo Li Xinbo Technology Co., Ltd.). Cervical exfoliated cells were collected and prepared into thin-layer cell smears with a diameter of 2 mm, fixed in 95% ethanol, and stained with hematoxylin and eosin. The cytological diagnosis was based on the 2014 WHO TBS (The Bethesda System) reporting system, which includes categories of negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells, cannot exclude HSIL (ASC-H), squamous cell carcinoma (SCC), and atypical glandular cells (AGC). The cytological specimens were reviewed and audited by senior cytopathologists. Colposcopy Our hospital used the Leisegang colposcopy produced by Germany. Referral indications for colposcopy examination are based on the 2012 ASCCP guidelines, which include HPV 16/18 infection, persistent high-risk HPV infection for more than 1 year, cytology ≥ LSIL, abnormal vaginal bleeding highly suspicious of cervical lesions, abnormal clinical symptoms or signs combined with high-risk HPV virus infection but normal cervical cytology. Under colposcopic guidance, multiple biopsies were taken to evaluate the extent and severity of the lesion, and endocervical curettage (ECC) was performed simultaneously for patients with highly suspicious cervical intraepithelial neoplasia (CIN) in the endocervical canal, acetowhite epithelium extending into the endocervical canal or type 3 of the transformation zone. Surgical approach and specimen fixation Our hospital used the SRD3000 high-frequency electric knife produced by Guangzhou Sanrui Medical Instrument Co.Ltd. (Product registration number: National Medical Products Administration [NMPA] [approval] No. 2014 3251665). Before the operation, the depth of individualized LEEP surgery was designed from the perspective of a patient's fertility requirments, based on the comprehensive and accurate colposcopic assessment of the TZ type, the extent of acetowhite epithelium (number of quadrants involved), as well as preoperative cervical cytology and cervical biopsy pathology results.The excisional margin should include 2–3 mm of normal tissue beyond the visible edge of the lesion.Two LEEPapproachs were used, including a "one-pass" and a “top-hat” LEEP. For patients with lesions extending into the endocervical canal or confirmed endocervical lesion on biopsy,a“ top-hat ” LEEP is performed. For patients with type 1/2 TZ,lesions visible only on the cervical surface or deeper in the cervix where the borders are visible, and no endocervical lesion is found on ECC, a "one-pass" LEEP procedure is performed.The surgery use a blend two coagulation setting of 35–40 W and a spray coagulation setting of 30W. After cervical LEEP, the edges of the cervical os are cauterized to control bleeding. For patients without bleeding, the edges are still cauterized to achieve physical therapy effects. The specimens were fixed in 10% buffered formalin solution after measurement and marked with silk threads through the cervical os at the 3 or 9 o'clock position. The length and thickness of the LEEP specimen were measured separately and recorded. Criteria for judgment This study only discussed the status of the endocervical margin of the LEEP specimen. For "one-pass" LEEP procedure, if the endocervical margin shows CIN2 + or if the distance between the lesion and margin is less than 1 mm, it is considered as a positive margin. If no CIN2 + lesion is found at the endocervical margin, it is considered as negative margin.For "top-hat" LEEP procedure, regardless of the status of the first pass excisional margin, if the second speicmen shows CIN2 + lesion, it is considered as a positive margin. Likewise, if no CIN2 + lesion is found on the second speicmen, it is considered as a negative margin.During the postoperative follow-up,detecting high-risk HPV is considered positive, and HPV negative or non-high-risk HPV positive are considered negative. Cervical stenosis or adhesion was defined as an obstruction of the cervical canal that interfered with subsequent cervical cytology or HPV sampling. Follow-up protocol Patients with negative endocervial margins after LEEP were followed up by HPV testing and cervical cytology every 6 months for 2 years. Patients with positive endocervical margins were followed up by HPV testing, cervical cytology, colposcopy, and ECC at 4–6 months postoperatively. If histological diagnosis confirmed CIN 2, CIN 2/3 or CIN3 during follow-up, repeat excision surgery was recommended. If recurrent histologic HSIL (CIN 2+) develops after excisional treatment, and repeat excision is not feasible or not desired, hysterectomy is recommended.Patients with normal histological findings continued to be followed up by HPV testing and cervical cytology. Statistical methods Statistical analysis was performed using SPSS 26.0 software. Continuous data were expressed as x ± s deviation and analyzed using independent samples t-test after confirming normal distribution through normality testing. Categorical data were expressed as frequencies and analyzed using either a univariate logistic regression or chi-square test. Ordinal data were analyzed using binary logistic regression. Multivariate logistic regression models were used to analyze the association between surgical margin status and preoperative evaluation indicators. A P value < 0.05 was considered statistically significant. Results 1. Factors related to the endocervical margin of cervical LEEP surgery Among the 151 patients who underwent LEEP surgery in outpatient, 131 had negative endocervical margins while 20 had positive endocervical margins, resulting in a endocervical margin positivity rate of 13.25%.The mean ages of patients with negative and positive endocervical margins were 35.27 ± 7.278 years and 37.30 ± 7.371 years, respectively, with no statistically significant difference between the two groups (P = 0.249). The study included 60 women with fertility requirements and 91 women without fertility requirements. There were significant differences between the two groups in terms of the design of the length (P < 0.001), thickness (P < 0.001), and surgical approach (P = 0.013) of cervical LEEP surgery, as shown in Table 2 . However, there was no statistically significant difference in the rate of positive endocervical margins between the two groups (P = 0.979). Univariate logistic regression analysis showed that preoperative cervical cytology (P = 0.040), the number of quadrants involved with acetowhite epithelium under colposcopy (P = 0.032), and cervical pathology results of biopsy (P = 0.028) were all statistically correlated with the endocervical margin status of LEEP specimens, as shown in Table 2 . Multivariate logistic regression analysis revealed that the number of quadrants involved with acetowhite epithelium under colposcopy (P = 0.034) and the cervical pathology results of biopsy(P = 0.020) were independent risk factors for a positive endocervical margin status in postoperative LEEP specimens, with a higher number of quadrants involved and a higher severity of lesions associated with a higher rate of positive endocervical margins, as shown in Table 4 . Table 2 Comparison of LEEP surgical design in patients with different reproductive requirements No Fertility requirements Fertility requirements P -Value Length of specimens 1.18 ± 0.337 0.93 ± 0.212 < 0.001 Thickness of specimens 1.11 ± 0.454 0.90 ± 0.329 < 0.001 Surgical approach : LEEP top-hat LEEP 69 55 22 5 0.013 Table 3 Univariable analysis of factors affecting the status of endocervical margins with cervical LEEP surgery. Negative endocervical margins Positive endocervical margins P-Value N=(131) N=(20) Age (year) a 35.27 ± 7.278 37.30 ± 7.371 0.249 Menopause : No 126 20 Yes 5 0 0.999 Fertility requirements : No 79 12 Yes 52 8 0.979 TCT : NILM 33 2 ASCUS/LSIL 61 8 ASC-H/HSIL/AGC/SCC 37 10 0.04 HPV : Non-16/18 hr-HPV positive 79 11 HPV 16/18 positive 52 9 0.653 TZ types : TZ 1 11 0 1 TZ 2 12 2 0.999 TZ 3 108 18 0.999 Number of quadrants involved by acetowhite epithelium : 1 24 1 2 49 5 3 18 4 4 40 10 0.032 Cervical pathology results of biopsy : CIN2 81 7 CIN2-3/CIN3 50 13 0.028 Cervical biopsy lesion involving the gland : No 87 10 Yes 44 10 0.159 Preoperative ECC statu : 6 No 51 0.073 Yes 38 11 0.102 Not examined 42 3 0.498 a Statitics presented: Median (IQR); Table 4 Multivariable analysis of factors affecting the status of endocervical margins with cervical LEEP surgery. OR (95% CI) P -Value TCT 1.562(0.730–3.344) 0.251 Number of quadrants involved by acetowhite epithelium 1.767 (1.044–2.991) 0.034 Cervical pathology results of biopsy 3.656 (1.227–10.890) 0.020 OR, odds ratio; 95% CI, 95% confidence interval; 2. The relationship between endocervical margin status and prognosis. Within the first six months after surgery, 98 patients (64.9%) underwent follow-up examinations, among which 70 cases were HPV-negative and 21 cases were HPV-positive for high-risk types. After one year, 140 patients (92.7%) underwent follow-up examinations, of which 107 cases were HPV-negative. All 151 patients completed the 2-year follow-up examination, with 128 testing negative for HPV, yielding an HPV clearance rate of 84.77% over 2 years.The rate of HPV persistence at 2 years after the surgery is 15.23%. The postoperative follow-up data of patients with different endocervical margin status showed no significant difference in the incidence of cervical stenosis or adhesion(P = 1.00). Results of HPV re-examination at different intervals after surgery (≤ 6 months,7–12 months,and 12–24 months) also showed no statistically significant differences between different endocervical margin status groups (P = 1.00, P = 0.984, and P = 0.382, respectively), as shown in Table 5 . Table 5 Postoperative cervical stenosis and HPV follow-up results in patients with different margin status after LEEP surgery. Negative endocervial margins N=(131) Positive endocervical margins N=(20) P -Value cervical stenosis : No Yes 128 20 3 0 1.000 HPV status within 6 months after surgery : Negative Positive 60 10 24 4 1.000 HPV status within 7–12 months after surgery : Negative Positive 54 7 10 2 0.984 HPV status within 12–24 months after surgery : Negative Positive 68 14 17 1 0.382 A total of 60 patients with referrals for colposcopy examination after surgery were identified, of whom 40 patients (66.7%) underwent colposcopy for re-evaluation. Six cases were confirmed cervical HSIL with biopsy, including five cases with positive endocervical margins and one case with negative endocervical margins but positive HPV re-examination. Ten cases were confirmed cervical LSIL with biopsy, while no abnormalities were detected in 19 cases,and five cases with normal colposcopic findings who did not undergo biopsy. Among the 20 patients who did not undergo colposcopic examination after surgery, 12 tested negative for HPV, while the remaining 8 patients are positive .In the present study, 4.6% of patients with follow-up(6 of 131) were diagnosed with residual HSIL. 3. The relationship between individualized LEEP surgical design,endocervical margin status and prognosis. Although there were significant differences in the individualized design of cervical LEEP surgery for women with different fertility requirements in this study, no statistical correlation was found between the length (P = 0.731), thickness (P = 0.603),or surgical method (P = 0.563) of individualized design of surgery and endocervical margin status. The mean ± SD cone length was 1.086 ± 0.317 cm for patients with negative endocervical margins and 1.055 ± 0.338cm for those with positive endocervical margins, which did not differ significantly (P = 0.692). In the present study,individualized LEEP surgery can remove approximately 58.9%, 80.1%, and 86.8% of lesions with a cone lengths ≤ 1cm, 1-1.5cm, and 1.5-2.0cm, respectively.There was no significant correlation between different cone lengths (P = 0.997), thickness (P = 0.180), or surgical approach (P = 0.956) and postoperative cervical stenosis or adhesions. There was also no significant correlation between different cone lengths, thickness, or surgical approach and HPV test results within the first 6 months (P = 0.438, P = 0.852, and P = 0.692, respectively), 7–12 months (P = 0.562, P = 0.718, and P = 1.000), or 12–24 months (P = 0.624, P = 0.608,and P = 0.860) after surgery, as shown in Table 6 . Table 6 The relationship between individualized cervical LEEP surgical design, endocervical margin status, and HPV clearance. Depth of Cervical Conization P -Value Thickness of Cervical Conization P -Value Cervical Conization P -Value ≤ 1.0cm 1.0cm-1.5cm >1.5cm ≤ 0.75cm 0.75cm-1.0cm > 1.0cm Leep top-hat Leep Status of endocervical margins : Negative 89 32 10 35 69 27 109 22 Positive 14 3 3 0.731 9 5 6 0.603 19 5 0.563 Cervical distortion : No 100 35 13 42 73 33 121 27 Yes 3 0 0 0.997 2 1 0 0.18 3 0 0.956 HPV status within 6 months after surgery : Negative 43 21 6 18 36 16 55 15 Positive 21 4 3 0.438 6 16 6 0.852 23 5 0.692 HPV status within 7–12 months after surgery : Negative 40 14 7 17 27 17 48 13 Positive 9 2 1 0.562 3 7 2 0.718 10 2 1 HPV status within 12–24 months after surgery : Negative 55 20 7 27 36 19 68 14 Positive 12 3 3 0.624 4 10 4 0.608 14 4 0.86 Discussion For patients with fertility requirements, determining the depth of cervical LEEP surgery based solely on the type of transformation zone may lead to problems such as excessive removal of normal cervical tissue and increased risk of adverse pregnancy outcomes. This study aims to establish an individualized LEEP surgical design from the perspective of a patient's fertility requirments, based on the comprehensive and accurate colposcopic evaluation,in combination with preoperative cervical cytology and cervical biopsy pathology, in order to achieve precise treatment. Achieving negative margins while removing lesions is often a common goal for both surgeons and patients. Some studies suggest that positive cone margins are an important predictive factor for residual or recurrence. [2,3] . A meta-analysis on inadequate removal of CIN lesions leading to treatment failure showed that the median rate of positive margins after cervical excisional treatment was 24% [4] , with cone margin positivity rates exceeding 40% in nine studies. The individualized design of LEEP surgery implemented in this study achieved an endocervical margin positivity rate of 13.25%,which is lower than the reported average levels, indicating that individualized LEEP surgical design is a feasible approach. This study found that factors affecting the endocervical margins of specimens mainly include preoperative cervical cytology, the number of quadrants affected by aceticacid epithelium under colposcopy, and the preoperative biopsy lesion grade. The more quadrants involved under colposcopy and a higher severity of lesions, the higher the rate of positive endocervical margins after cone excision. Similar conclusions were reached in studies by Chumnan Kietpeerakool [4] , Jun-yu Chen [5] , Renata B Simões [6] . Therefore, for patients with large and high-grade lesions, a sufficiently large surgical range should be designed. These procedures not only have a higher rate of positive margins but also may conceal higher-grade lesions. Currently, postoperative HPV testing is considered the most accurate predictor of residual/recurrence in patients with HSILof cervix [7,8] ,which has a much higher predictive ability for CIN2 + lesion residual/reccurence (91%) and a negative predictive value of 100% [9] .In contrast, positive surgical margins in postoperative samples can only predict about 56% of lesion residual/recurrence. At the same time, Kucera et al. believe that effective treatment for pre-cancerous cervical lesions requires not only lesion removal but also eradication of HPV infection [10] . Therefore, this study chose postoperative HPV testing results as an alternative indicator for measuring disease prognosis. HPV persistence was defined as the presence of the same HPV type before surgery and at the first follow-up visit after surgery(generally at 6 months after the surgery) [11–13] .This study showed that the rate of persistent HPV infection at 2 years after LEEP surgery was 15.23%. The follow-up HPV testing conducted at 6 months, 6–12 months, and 12–24 months after surgery showed no statistically significant difference in the rate of persistent infection between the positive and negative endocervial margins groups. These results suggest that positive endocervial margins did not increase the risk of postoperative HPV persistent infection.A cohort study of 1029 patients also arrived at the same conclusion [12] . Furthermore, some studies have indicated that there is a significant increase in HPV persistence rates among positive margin patients compared to negative margin ones within the first six months after surgery. However, this difference disappears after 3–5 years of follow-up [14] .Current reports on postoperative HPV persistence rates vary significantly due to the differences in patient characteristics and follow-up time points across studies.Yung-Taek Ouh et al. found that the rate of postoperative persistent HPV infection was approximately 38.7% at 6 months after surgery. Among those with persistent infection, about 9.7% were confirmed to have residual lesions [15] .Yutaka Nagai et al. detected that CIN3 patients who underwent cone biopsy had an average follow-up of 31.8 months, and the rate of persistent HPV infection was approximately 19.6%. There are about 45.5% experienced lesion recurrence among them [16] . Some studies also suggest that the rate of persistent HPV infection among negative-margin patients was 45.5% at 3 months after surgery, but decreased to 14.3% at 6 months after surgery [17] . There are 85.6% of the patients in this study had TZ3-type lesions ,but they underwent individualized LEEP treatment plans which are different with traditional cervical conization, The results showed that LEEP with cone lengths of ≤ 1cm, 1-1.5cm, and 1.5-2.0cm could remove approximately 58.9%, 80.1%, and 86.8% of the lesions, respectively. After a 2-year follow-up, the residual lesion rate was only 4.6%, which was lower than the reported residual/recurrence rates of 5–15% after LEEP [18] . This suggests that individualized LEEP design not only removes less tissue but also does not affect disease prognosis. One possible reason is related to full electrosurgical coagulation of the margin after cutting, which not only stops bleeding but also destroys any remaining lesions. On the other hand, tissue repair after LEEP surgery can mobilize local immune function to clear the virus. But the effects of these two procedures are difficult to measure with objective standards.There are also relevant reports, such as the study by Theresa Maria Kolben et al., which suggests that compared with traditional cone excision, only removing the lesion site may have higher rates of positive margins but does not reduce HPV clearance rates and results in a smaller volume of cervical tissue removed [19] . Another study on cervical HPV-infected women undergoing 5–8 mm-deep cone excision found significant differences in HPV clearance rates at 6 and 12 months after surgery compared to the untreated group. This study believes that LEEP surgery itself can accelerate HPV clearance [20] . Of course, there are completely different views. The study by Ghaem-Maghami et al. found that the postoperative HSIL detection rate was 3% and 18% for patients with negative margins and positive/uncertain margins, respectively. They believe that cone excision should strive to remove lesions as cleanly as possible to achieve negative margins [2] . Therefore, there has been ongoing discussion regarding the depth of individualized cervical conization procedures.Some studies suggest that about 86% of CIN3 lesions are shorter than 10mm, and even lesions confined to the cervix are generally difficult to extend beyond 22mm above the cervix external os [21] . Kliemann et al. found that when the depth of cone excision reaches 11mm, 13mm, and 20mm, approximately 90%, 95%, and 100% of CIN2-3 lesions can be removed, respectively [22] , supporting the feasibility of our approach.Some studies suggest that to achieve a negative margin, lesions in women under 40 years old with CIN2 or CIN3 + require a minimum depth of excision of 0.9cm and 1.8cm, respectively. For women between 40–50 years old, the minimum depth of excision for CIN2 and CIN3 + lesions is 1.2cm and 1.8cm [23] . These study results indicate that most patients do not need to be cut too deeply.However, in the opinion of the author, individualized surgical excision combined with full electrosurgical coagulation can avoid excessive removal of cervical tissue and does not affect the prognosis of the lesion for women with fertility requirements, meanwhile reducing the risk of adverse pregnancy outcomes ,which will be a feasible and effective treatment method. This study did not find any correlation between age, endocervical margin status, surgical design, and postoperative HPV clearance. It is possible that this is due to the fact that all surgeries were performed in the outpatient setting, with the vast majority being women of childbearing age. Therefore, additional case data from other age groups needs to be added in the future to obtain more comprehensive and objective conclusions. The advantages of individualized LEEP surgical design should not only include the evaluation of its effects on margin status, disease prognosis, and postoperative cervical morphology but also focus on the assessment of subsequent fertility and pregnancy outcomes for women with fertility requirements. Unfortunately, as for now, not all 68 female patients' pregnancy outcomes have been followed up. Some patients are seeking assisted reproduction, and whether this is related to the surgery still needs further follow-up and data collection. In conclusion, this study suggests that an individualized cervical LEEP surgical design, which prioritizes patients' fertility requirements, and based on comprehensive and precise assessments using colposcopy, is a safe, effective, and feasible approach. This conforms to the trend of precision medicine and offers greater benefits for women with fertility requirements. Declarations Author Contribution T. L. and H.L.: Conceptualization, Methodology, Data curation, Writing - original draft. X. L.: Review & Editing. G. H.: Data curation. W. W.: Formal analysis. B. M.: Data Curation. Y. Z.: Formal Analysis. T. L.: Review & Editing, Validation. Declaration of Competing Interest The authors made no disclosures. No specific funding was disclosed. References Rivoire WA, Monego HI, Dos Reis R, Binda MA, Magno V, Tavares EB, et al. Comparison of loop electrosurgical conization with one or two passes in high-grade cervical intraepithelial neoplasias. Gynecol Obstet Invest. 2009;67(4):228–35. https://doi.org/10.1159/000209214 PMID: 19293589 Ghaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. The Lancet Oncology. 2007 Nov 1;8(11):985–93. https://doi.org/10.1016/S1470-2045(07)70283-8 Oliveira CA de, Russomano FB, Gomes Júnior SC dos S, Corrêa F de M. Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis. Sao Paulo Med J. 2012;130(2):119–25. https://doi.org/10.1590/s1516-31802012000200009 PMID: 22481759 Kietpeerakool C, Khunamornpong S, Srisomboon J, Siriaunkgul S, Suprasert P. Cervical intraepithelial neoplasia II-III with endocervical cone margin involvement after cervical loop conization: is there any predictor for residual disease? J Obstet Gynaecol Res. 2007 Oct;33(5):660–4. https://doi.org/10.1111/j.1447-0756.2007.00628.x PMID: 17845326 Chen J-Y, Wang Z-L, Wang Z-Y, Yang X-S. The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization. Medicine (Baltimore). 2018 Oct;97(41):e12792. https://doi.org/10.1097/MD.0000000000012792 PMID: 30313104 Simões RB, Campaner AB. 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Int J Cancer. 2011 Aug 15;129(4):903–9. https://doi.org/10.1002/ijc.25745 PMID: 21064091 Kucera E, Sliutz G, Czerwenka K, Breitenecker G, Leodolter S, Reinthaller A. Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone? Eur J Obstet Gynecol Reprod Biol. 2001 Dec 10;100(1):72–6. https://doi.org/10.1016/s0301-2115(01)00457-2 PMID: 11728661 Bogani G, Pinelli C, Chiappa V, Martinelli F, Lopez S, Ditto A, et al. Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women. J Gynecol Oncol. 2020 Sep;31(5):e60. https://doi.org/10.3802/jgo.2020.31.e60 PMID: 32808492 Ouh Y-T, Cho HW, Kim SM, Min K-J, Lee S-H, Song J-Y, et al. Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment. Obstet Gynecol Sci. 2020 Sep;63(5):631–42. https://doi.org/10.5468/ogs.20049 PMID: 32693443 Hoffman SR, Le T, Lockhart A, Sanusi A, Dal Santo L, Davis M, et al. Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review. Int J Cancer. 2017 Jul 1;141(1):8–23. https://doi.org/10.1002/ijc.30623 PMID: 28124442 Rizzuto I, Nalam M, Jiang J, Linder A, Rufford B. Risk factors for HPV persistence and cytology anomalies at follow-up after treatment for cervical dysplasia. Int J Gynaecol Obstet. 2018 May;141(2):240–4. https://doi.org/10.1002/ijgo.12431 PMID: 29250779 Ouh Y-T, Cho HW, Kim SM, Min K-J, Lee S-H, Song J-Y, et al. Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment. Obstet Gynecol Sci. 2020 Sep;63(5):631–42. https://doi.org/10.5468/ogs.20049 PMID: 32693443 Nagai Y, Maehama T, Asato T, Kanazawa K. Persistence of human papillomavirus infection after therapeutic conization for CIN 3: is it an alarm for disease recurrence? Gynecol Oncol. 2000 Nov;79(2):294–9. https://doi.org/10.1006/gyno.2000.5952 PMID: 11063660 Kim Y-T, Lee JM, Hur S-Y, Cho C-H, Kim YT, Kim SC, et al. Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia. Int J Cancer. 2010 Apr 15;126(8):1903–9. https://doi.org/10.1002/ijc.24794 PMID: 19642095 Ang C, Mukhopadhyay A, Burnley C, Faulkner K, Cross P, Martin-Hirsch P, et al. Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG. 2011 May;118(6):685–92. https://doi.org/10.1111/j.1471-0528.2011.02929.x PMID: 21429068 Kolben TM, Etzel LT, Bergauer F, Hagemann I, Hillemanns P, Repper M, et al. A randomized trial comparing limited-excision conisation to Large Loop Excision of the Transformation Zone (LLETZ) in cervical dysplasia patients. J Gynecol Oncol. 2019 May;30(3):e42. https://doi.org/10.3802/jgo.2019.30.e42 PMID: 30887760 Zhang W, Gong X, Wu Q, Liu Y, Lao G, Xiao J, et al. The Clearance of High-Risk Human Papillomavirus is Sooner After Thin Loop Electrosurgical Excision Procedure (t-LEEP). J Invest Surg. 2019 Sep;32(6):560–5. https://doi.org/10.1080/08941939.2018.1483449 PMID: 30212232 Indman PD. Modern Colposcopy: Textbook and Atlas (Third Edition). Journal of Minimally Invasive Gynecology. 2012 Jul 1;19(4):538. https://doi.org/10.1016/j.jmig.2012.03.002 Kliemann LM, Silva M, Reinheimer M, Rivoire WA, Capp E, Dos Reis R. Minimal cold knife conization height for high-grade cervical squamous intraepithelial lesion treatment. Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):342–6. https://doi.org/10.1016/j.ejogrb.2012.08.016 PMID: 22948133 Bae HS, Chung YW, Kim T, Lee KW, Song JY. The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity. Acta Obstet Gynecol Scand. 2013 Feb;92(2):185–92. https://doi.org/10.1111/aogs.12025 PMID: 23034067 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3973268","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":274684360,"identity":"302c5947-dbc2-4f44-8b8e-97f7764a7647","order_by":0,"name":"Tingyan Liu","email":"","orcid":"","institution":"Guangdong Province Women and Children Hospital","correspondingAuthor":false,"prefix":"","firstName":"Tingyan","middleName":"","lastName":"Liu","suffix":""},{"id":274684361,"identity":"e04f5a01-cfb8-4bbf-baa7-520cbda85c6c","order_by":1,"name":"Weijia Wang","email":"","orcid":"","institution":"Guangdong Province Women and Children Hospital","correspondingAuthor":false,"prefix":"","firstName":"Weijia","middleName":"","lastName":"Wang","suffix":""},{"id":274684362,"identity":"68fac44b-09e6-4083-9039-7c4c7d9108e4","order_by":2,"name":"Huiming Liao","email":"","orcid":"","institution":"Guangdong Province Women and Children Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huiming","middleName":"","lastName":"Liao","suffix":""},{"id":274684363,"identity":"62fbc826-9145-4cc2-ba9d-d1bbcff31d97","order_by":3,"name":"Yun Zhao","email":"","orcid":"","institution":"Peking University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yun","middleName":"","lastName":"Zhao","suffix":""},{"id":274684364,"identity":"d8cc3e6e-a273-4a83-8c9b-a5d9b5f3c131","order_by":4,"name":"Bi Mai","email":"","orcid":"","institution":"Guangdong Province Women and Children Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bi","middleName":"","lastName":"Mai","suffix":""},{"id":274684365,"identity":"85949f66-d2f3-4d64-82b6-42b5054ba30f","order_by":5,"name":"Guiying Hu","email":"","orcid":"","institution":"Guangdong Province Women and Children Hospital","correspondingAuthor":false,"prefix":"","firstName":"Guiying","middleName":"","lastName":"Hu","suffix":""},{"id":274684366,"identity":"a1cbb6c7-a099-455e-ad09-3ef7502bd287","order_by":6,"name":"Xiping Luo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBACPhCRwCDBwMDffvjBBwMbOYJa2OBaJM6kGc4oSDMmTgsEJBhI83w4nEhYi0TyMYmHOyzy5B0OJBjbGDAnMLAfProBv5a0ZIPEMxLFhocbDzzOMWDLY+BJS7uBX0uO4YPENonEjQ1AW3IMeIoZJHjMCGkxOADRAvSLhYFEYgMRWiC2zAd5n8HAgAgtPM/AfkncAArkHoMEYzZCfuFnTz4m+XNHXeL8fmBU/vjzX46f/fAxvFrAgLGBgcHgAMxegsphWuQbiFI6CkbBKBgFIxEAALKFSTeTBrFzAAAAAElFTkSuQmCC","orcid":"","institution":"Guangdong Province Women and Children Hospital","correspondingAuthor":true,"prefix":"","firstName":"Xiping","middleName":"","lastName":"Luo","suffix":""}],"badges":[],"createdAt":"2024-02-20 16:05:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3973268/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3973268/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52971131,"identity":"247471fe-93b2-4468-8190-d36d094213df","added_by":"auto","created_at":"2024-03-19 08:21:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":569542,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3973268/v1/a802dbf5-3d6b-4548-a328-75f3c838bc8a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The impact of individualized design of cervical LEEP surgery on endocervical margin status and disease prognosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEarly detection of precancerous lesions of the cervix and selecting appropriate treatment methods is an important measure for preventing cervical cancer.At present, the preferred treatment for high-grade squamous intraepithelial lesion (HSIL) of the cervix is cervical conization .The loop electrosurgical excision procedure (LEEP) is the most commonly used, convenient, safe, and effective surgical method\u003csup\u003e[1]\u003c/sup\u003e .While the cervical LEEP procedure itself is relatively simple, achieving satisfactory outcomes requires precise surgical design. This is especially important for older women with fertility requirements, as excessive treatment may lead to adverse pregnancy outcomes, while insufficient treatment can increase the risk of repeat treatments. Therefore, the main focus of this study is to explore how to individualize the surgical design of LEEP procedure based on comprehensive colposcopy assessment to achieve optimal disease prognosis.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\n\u003ch2\u003eParticipants:\u003c/h2\u003e\n\u003cp\u003eThis study collected data from 151 patients who underwent cervical LEEP surgery for HSIL at Guangdong Women and Children Hospital outpatient clinic between January 2015 and December 2019. The mean age of the patients was 35.54\u0026thinsp;\u0026plusmn;\u0026thinsp;7.298 years, with an average age of 39.87\u0026thinsp;\u0026plusmn;\u0026thinsp;7.038 years for patients without fertility requirements and an average age of 30.50\u0026thinsp;\u0026plusmn;\u0026thinsp;4.115 years for patients with fertility requirements. The study primarily collected the following patient information: age, fertility desire, menstrual status, preoperative cervical cytology and HPV typing, type of transformation zone (TZ) and number of quadrants involved by acetowhite epithelium under colposcopy, cervical pathology results of biopsy (including presence of glandular involvement), and preoperative pathology results of endocervical curettage (ECC),surgical approach and endocervical margins status. We review the further details on the clinicopathologic characteristics of the patients,(Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ctable border=\"1\" width=\"526\"\u003e\u003ccaption\u003e\n\u003cp\u003eTable 1\u003c/p\u003e\n\u003cp\u003eBaseline of clinicopathologic characteristics\u003c/p\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003ctd width=\"184\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003eN=151\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;n\u003c/strong\u003e\u003cstrong\u003e（\u003c/strong\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003cstrong\u003e）\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eMenopause:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e146\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e96.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e3.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eFertility requirements\u003c/strong\u003e:\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e91\u003c/p\u003e\n\u003cp\u003e60\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e60.3\u003c/p\u003e\n\u003cp\u003e39.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eHPV status before surgery:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNon-16/18 hr-HPV positive\u003c/p\u003e\n\u003cp\u003eHPV 16/18 positive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e90\u003c/p\u003e\n\u003cp\u003e61\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e59.6\u003c/p\u003e\n\u003cp\u003e40.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eTCT:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNILM\u003c/p\u003e\n\u003cp\u003eASC-US/LSIL\u003c/p\u003e\n\u003cp\u003eASC-H/HSIL/AGC/SCC\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e35\u003c/p\u003e\n\u003cp\u003e69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e23.2\u003c/p\u003e\n\u003cp\u003e45.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e31.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eCervical pathology results of biopsy:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHSIL(CIN2)\u003c/p\u003e\n\u003cp\u003eHSIL(CIN2-3、CIN3)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e88\u003c/p\u003e\n\u003cp\u003e63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e58.3\u003c/p\u003e\n\u003cp\u003e41.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eTZ types\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTZ1\u003c/p\u003e\n\u003cp\u003eTZ2\u003c/p\u003e\n\u003cp\u003eTZ3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e11\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e7.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e9.3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e126\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e83.4\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eNumber of quadrants involved by acetowhite epithelium:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1\u003c/p\u003e\n\u003cp\u003e2\u003c/p\u003e\n\u003cp\u003e3\u003c/p\u003e\n\u003cp\u003e4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e25\u003c/p\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e16.6\u003c/p\u003e\n\u003cp\u003e35.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e22\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e14.6\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e50\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e33.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eCervical Intraepithelial Neoplasia Glandular Involvement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e97\u003c/p\u003e\n\u003cp\u003e54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e64.2\u003c/p\u003e\n\u003cp\u003e35.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"3\" width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eECC:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eUnknown\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e57\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e37.7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e49\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e32.5\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e29.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eSurgical approach:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLEEP\u003c/p\u003e\n\u003cp\u003etop-hat LEEP\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e124\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e82.1\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e17.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"184\"\u003e\n\u003cp\u003e\u003cstrong\u003eStatus of endocervical margins:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNegative\u003c/p\u003e\n\u003cp\u003epositive\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"187\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e131\u003c/p\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"156\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e86.8\u003c/p\u003e\n\u003cp\u003e13.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNILM, 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 which did not exclude high-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion; hr-HPV, high-risk human papillomavirus; TZ, transformation zone; ECC, endocervical curettage;\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eDesign and setting\u003c/h2\u003e\n\u003cp\u003eAll patients were screened using cervical liquid-based cytology combined with HPV typing. Patients with abnormal screening results were referred for colposcopy. Multiple biopsies were taken to confirm the diagnosis. For patients with pathologically proven HSIL, the colposcopist conducted individualized LEEP surgical design from the perspective of a patient's fertility requirments, based on the comprehensive and accurate colposcopic assessment of the TZ type, the extent of acetowhite epithelium (number of quadrants involved), as well as preoperative cervical cytology and cervical biopsy pathology results.After the surgery, specimen length, thickness, and surgical approach were measured and recorded in detail. Post-operatively, pathological results and endocervical margin status were monitored.All patients signed an informed consent form before the operation, and a follow-up plan was formulated after the pathological results were reported, with the signing of a postoperative follow-up informed consent form. Follow-up tests were conducted using cervical liquid-based cytology combined with HPV testing. The presence of cervical adhesions or stenosis at the external os after surgery was documented, and HPV test results were collected within 6 months, from 7\u0026ndash;12 months, and 12\u0026ndash;24 months after surgery.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003eHPV testing\u003c/h2\u003e\n\u003cp\u003eThis study used a 21-type HPV gene microarray typing kit produced by Guangdong Kepu Biotechnology Co., Ltd., which was approved by the China National Medical Products Administration. The HPV types detected included 13 high-risk types (16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68), 5 low-risk types (6, 11, 42, 43, 44), and 3 other subtypes (53, 66, CP8304).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003eCervical liquid-based cytology\u003c/h2\u003e\n\u003cp\u003eOur hospital used the ThinPrep liquid-based cytology examination (TCT liquid-based cell preparation instrument produced by Beijing Yingshuo Li Xinbo Technology Co., Ltd.). Cervical exfoliated cells were collected and prepared into thin-layer cell smears with a diameter of 2 mm, fixed in 95% ethanol, and stained with hematoxylin and eosin. The cytological diagnosis was based on the 2014 WHO TBS (The Bethesda System) reporting system, which includes categories of negative for intraepithelial lesion or malignancy (NILM), atypical squamous cells of undetermined significance (ASC-US), low-grade squamous intraepithelial lesion (LSIL), high-grade squamous intraepithelial lesion (HSIL), atypical squamous cells, cannot exclude HSIL (ASC-H), squamous cell carcinoma (SCC), and atypical glandular cells (AGC). The cytological specimens were reviewed and audited by senior cytopathologists.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003eColposcopy\u003c/h2\u003e\n\u003cp\u003eOur hospital used the Leisegang colposcopy produced by Germany. Referral indications for colposcopy examination are based on the 2012 ASCCP guidelines, which include HPV 16/18 infection, persistent high-risk HPV infection for more than 1 year, cytology\u0026thinsp;\u0026ge;\u0026thinsp;LSIL, abnormal vaginal bleeding highly suspicious of cervical lesions, abnormal clinical symptoms or signs combined with high-risk HPV virus infection but normal cervical cytology. Under colposcopic guidance, multiple biopsies were taken to evaluate the extent and severity of the lesion, and endocervical curettage (ECC) was performed simultaneously for patients with highly suspicious cervical intraepithelial neoplasia (CIN) in the endocervical canal, acetowhite epithelium extending into the endocervical canal or type 3 of the transformation zone.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n\u003ch2\u003eSurgical approach and specimen fixation\u003c/h2\u003e\n\u003cp\u003eOur hospital used the SRD3000 high-frequency electric knife produced by Guangzhou Sanrui Medical Instrument Co.Ltd. (Product registration number: National Medical Products Administration [NMPA] [approval] No. 2014 3251665). Before the operation, the depth of individualized LEEP surgery was designed from the perspective of a patient's fertility requirments, based on the comprehensive and accurate colposcopic assessment of the TZ type, the extent of acetowhite epithelium (number of quadrants involved), as well as preoperative cervical cytology and cervical biopsy pathology results.The excisional margin should include 2\u0026ndash;3 mm of normal tissue beyond the visible edge of the lesion.Two LEEPapproachs were used, including a \"one-pass\" and a \u0026ldquo;top-hat\u0026rdquo; LEEP. For patients with lesions extending into the endocervical canal or confirmed endocervical lesion on biopsy,a\u0026ldquo; top-hat \u0026rdquo; LEEP is performed. For patients with type 1/2 TZ,lesions visible only on the cervical surface or deeper in the cervix where the borders are visible, and no endocervical lesion is found on ECC, a \"one-pass\" LEEP procedure is performed.The surgery use a blend two coagulation setting of 35\u0026ndash;40 W and a spray coagulation setting of 30W. After cervical LEEP, the edges of the cervical os are cauterized to control bleeding. For patients without bleeding, the edges are still cauterized to achieve physical therapy effects.\u003c/p\u003e\n\u003cp\u003eThe specimens were fixed in 10% buffered formalin solution after measurement and marked with silk threads through the cervical os at the 3 or 9 o'clock position. The length and thickness of the LEEP specimen were measured separately and recorded.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n\u003ch2\u003eCriteria for judgment\u003c/h2\u003e\n\u003cp\u003eThis study only discussed the status of the endocervical margin of the LEEP specimen. For \"one-pass\" LEEP procedure, if the endocervical margin shows CIN2\u0026thinsp;+\u0026thinsp;or if the distance between the lesion and margin is less than 1 mm, it is considered as a positive margin. If no CIN2\u0026thinsp;+\u0026thinsp;lesion is found at the endocervical margin, it is considered as negative margin.For \"top-hat\" LEEP procedure, regardless of the status of the first pass excisional margin, if the second speicmen shows CIN2\u0026thinsp;+\u0026thinsp;lesion, it is considered as a positive margin. Likewise, if no CIN2\u0026thinsp;+\u0026thinsp;lesion is found on the second speicmen, it is considered as a negative margin.During the postoperative follow-up,detecting high-risk HPV is considered positive, and HPV negative or non-high-risk HPV positive are considered negative. Cervical stenosis or adhesion was defined as an obstruction of the cervical canal that interfered with subsequent cervical cytology or HPV sampling.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n\u003ch2\u003eFollow-up protocol\u003c/h2\u003e\n\u003cp\u003ePatients with negative endocervial margins after LEEP were followed up by HPV testing and cervical cytology every 6 months for 2 years. Patients with positive endocervical margins were followed up by HPV testing, cervical cytology, colposcopy, and ECC at 4\u0026ndash;6 months postoperatively. If histological diagnosis confirmed CIN 2, CIN 2/3 or CIN3 during follow-up, repeat excision surgery was recommended. If recurrent histologic HSIL (CIN 2+) develops after excisional treatment, and repeat excision is not feasible or not desired, hysterectomy is recommended.Patients with normal histological findings continued to be followed up by HPV testing and cervical cytology.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\n\u003ch2\u003eStatistical methods\u003c/h2\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS 26.0 software. Continuous data were expressed as x\u0026thinsp;\u0026plusmn;\u0026thinsp;s deviation and analyzed using independent samples t-test after confirming normal distribution through normality testing. Categorical data were expressed as frequencies and analyzed using either a univariate logistic regression or chi-square test. Ordinal data were analyzed using binary logistic regression. Multivariate logistic regression models were used to analyze the association between surgical margin status and preoperative evaluation indicators. A P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e1. Factors related to the endocervical margin of cervical LEEP surgery\u003c/p\u003e\n\u003cp\u003eAmong the 151 patients who underwent LEEP surgery in outpatient, 131 had negative endocervical margins while 20 had positive endocervical margins, resulting in a endocervical margin positivity rate of 13.25%.The mean ages of patients with negative and positive endocervical margins were 35.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.278 years and 37.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.371 years, respectively, with no statistically significant difference between the two groups (P\u0026thinsp;=\u0026thinsp;0.249). The study included 60 women with fertility requirements and 91 women without fertility requirements. There were significant differences between the two groups in terms of the design of the length (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), thickness (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and surgical approach (P\u0026thinsp;=\u0026thinsp;0.013) of cervical LEEP surgery, as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. However, there was no statistically significant difference in the rate of positive endocervical margins between the two groups (P\u0026thinsp;=\u0026thinsp;0.979). Univariate logistic regression analysis showed that preoperative cervical cytology (P\u0026thinsp;=\u0026thinsp;0.040), the number of quadrants involved with acetowhite epithelium under colposcopy (P\u0026thinsp;=\u0026thinsp;0.032), and cervical pathology results of biopsy (P\u0026thinsp;=\u0026thinsp;0.028) were all statistically correlated with the endocervical margin status of LEEP specimens, as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. Multivariate logistic regression analysis revealed that the number of quadrants involved with acetowhite epithelium under colposcopy (P\u0026thinsp;=\u0026thinsp;0.034) and the cervical pathology results of biopsy(P\u0026thinsp;=\u0026thinsp;0.020) were independent risk factors for a positive endocervical margin status in postoperative LEEP specimens, with a higher number of quadrants involved and a higher severity of lesions associated with a higher rate of positive endocervical margins, as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of LEEP surgical design in patients with different reproductive requirements\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo Fertility requirements\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFertility requirements\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of specimens\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.93\u0026thinsp;\u0026plusmn;\u0026thinsp;0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eThickness of specimens\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.11\u0026thinsp;\u0026plusmn;\u0026thinsp;0.454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.90\u0026thinsp;\u0026plusmn;\u0026thinsp;0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurgical approach\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003eLEEP\u003c/p\u003e\n \u003cp\u003etop-hat LEEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eUnivariable analysis of factors affecting the status of endocervical margins with cervical LEEP surgery.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative endocervical margins\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive endocervical margins\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN=(131)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN=(20)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (year)\u003c/strong\u003e\u003csup\u003e\u003cstrong\u003ea\u003c/strong\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.27\u0026thinsp;\u0026plusmn;\u0026thinsp;7.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.30\u0026thinsp;\u0026plusmn;\u0026thinsp;7.371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.249\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMenopause\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFertility requirements\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.979\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTCT\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNILM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASCUS/LSIL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eASC-H/HSIL/AGC/SCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNon-16/18 hr-HPV positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHPV 16/18 positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.653\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTZ types\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTZ 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTZ 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTZ 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of quadrants involved\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eby acetowhite epithelium\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCervical pathology results of biopsy\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIN2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCIN2-3/CIN3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCervical biopsy lesion involving the gland\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.159\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePreoperative ECC statu\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.102\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot examined\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003csup\u003ea\u003c/sup\u003e Statitics presented: Median (IQR);\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariable analysis of factors affecting the status of endocervical margins with cervical LEEP surgery.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTCT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.562(0.730\u0026ndash;3.344)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of quadrants involved by acetowhite epithelium\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.767 (1.044\u0026ndash;2.991)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCervical pathology results of biopsy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3.656 (1.227\u0026ndash;10.890)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eOR, odds ratio; 95% CI, 95% confidence interval;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e2. The relationship between endocervical margin status and prognosis.\u003c/p\u003e\n\u003cp\u003eWithin the first six months after surgery, 98 patients (64.9%) underwent follow-up examinations, among which 70 cases were HPV-negative and 21 cases were HPV-positive for high-risk types. After one year, 140 patients (92.7%) underwent follow-up examinations, of which 107 cases were HPV-negative. All 151 patients completed the 2-year follow-up examination, with 128 testing negative for HPV, yielding an HPV clearance rate of 84.77% over 2 years.The rate of HPV persistence at 2 years after the surgery is 15.23%.\u003c/p\u003e\n\u003cp\u003eThe postoperative follow-up data of patients with different endocervical margin status showed no significant difference in the incidence of cervical stenosis or adhesion(P\u0026thinsp;=\u0026thinsp;1.00). Results of HPV re-examination at different intervals after surgery (\u0026le;\u0026thinsp;6 months,7\u0026ndash;12 months,and 12\u0026ndash;24 months) also showed no statistically significant differences between different endocervical margin status groups (P\u0026thinsp;=\u0026thinsp;1.00, P\u0026thinsp;=\u0026thinsp;0.984, and P\u0026thinsp;=\u0026thinsp;0.382, respectively), as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePostoperative cervical stenosis and HPV follow-up results in patients with different margin status after LEEP surgery.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNegative endocervial margins\u003c/p\u003e\n \u003cp\u003eN=(131)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePositive endocervical margins\u003c/p\u003e\n \u003cp\u003eN=(20)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ecervical stenosis\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV status within 6 months after surgery\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV status within 7\u0026ndash;12 months after surgery\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV status within 12\u0026ndash;24 months after surgery\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.382\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA total of 60 patients with referrals for colposcopy examination after surgery were identified, of whom 40 patients (66.7%) underwent colposcopy for re-evaluation. Six cases were confirmed cervical HSIL with biopsy, including five cases with positive endocervical margins and one case with negative endocervical margins but positive HPV re-examination. Ten cases were confirmed cervical LSIL with biopsy, while no abnormalities were detected in 19 cases,and five cases with normal colposcopic findings who did not undergo biopsy. Among the 20 patients who did not undergo colposcopic examination after surgery, 12 tested negative for HPV, while the remaining 8 patients are positive .In the present study, 4.6% of patients with follow-up(6 of 131) were diagnosed with residual HSIL.\u003c/p\u003e\n\u003cp\u003e3. The relationship between individualized LEEP surgical design,endocervical margin status and prognosis.\u003c/p\u003e\n\u003cp\u003eAlthough there were significant differences in the individualized design of cervical LEEP surgery for women with different fertility requirements in this study, no statistical correlation was found between the length (P\u0026thinsp;=\u0026thinsp;0.731), thickness (P\u0026thinsp;=\u0026thinsp;0.603),or surgical method (P\u0026thinsp;=\u0026thinsp;0.563) of individualized design of surgery and endocervical margin status. The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD cone length was 1.086\u0026thinsp;\u0026plusmn;\u0026thinsp;0.317 cm for patients with negative endocervical margins and 1.055\u0026thinsp;\u0026plusmn;\u0026thinsp;0.338cm for those with positive endocervical margins, which did not differ significantly (P\u0026thinsp;=\u0026thinsp;0.692). In the present study,individualized LEEP surgery can remove approximately 58.9%, 80.1%, and 86.8% of lesions with a cone lengths\u0026thinsp;\u0026le;\u0026thinsp;1cm, 1-1.5cm, and 1.5-2.0cm, respectively.There was no significant correlation between different cone lengths (P\u0026thinsp;=\u0026thinsp;0.997), thickness (P\u0026thinsp;=\u0026thinsp;0.180), or surgical approach (P\u0026thinsp;=\u0026thinsp;0.956) and postoperative cervical stenosis or adhesions. There was also no significant correlation between different cone lengths, thickness, or surgical approach and HPV test results within the first 6 months (P\u0026thinsp;=\u0026thinsp;0.438, P\u0026thinsp;=\u0026thinsp;0.852, and P\u0026thinsp;=\u0026thinsp;0.692, respectively), 7\u0026ndash;12 months (P\u0026thinsp;=\u0026thinsp;0.562, P\u0026thinsp;=\u0026thinsp;0.718, and P\u0026thinsp;=\u0026thinsp;1.000), or 12\u0026ndash;24 months (P\u0026thinsp;=\u0026thinsp;0.624, P\u0026thinsp;=\u0026thinsp;0.608,and P\u0026thinsp;=\u0026thinsp;0.860) after surgery, as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe relationship between individualized cervical LEEP surgical design, endocervical margin status, and HPV clearance.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eDepth of Cervical Conization\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"3\" align=\"left\"\u003e\n \u003cp\u003eThickness of Cervical Conization\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eCervical Conization\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-Value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;1.0cm\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e1.0cm-1.5cm\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;1.5cm\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;0.75cm\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e0.75cm-1.0cm\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;1.0cm\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLeep\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003etop-hat Leep\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatus of endocervical margins\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.731\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.563\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCervical distortion\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV status within 6 months after surgery\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV status within 7\u0026ndash;12 months after surgery\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.562\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.718\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eHPV status within 12\u0026ndash;24 months after surgery\u003c/strong\u003e:\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eFor patients with fertility requirements, determining the depth of cervical LEEP surgery based solely on the type of transformation zone may lead to problems such as excessive removal of normal cervical tissue and increased risk of adverse pregnancy outcomes. This study aims to establish an individualized LEEP surgical design from the perspective of a patient's fertility requirments, based on the comprehensive and accurate colposcopic evaluation,in combination with preoperative cervical cytology and cervical biopsy pathology, in order to achieve precise treatment.\u003c/p\u003e\n\u003cp\u003eAchieving negative margins while removing lesions is often a common goal for both surgeons and patients. Some studies suggest that positive cone margins are an important predictive factor for residual or recurrence.\u003csup\u003e[2,3]\u003c/sup\u003e. A meta-analysis on inadequate removal of CIN lesions leading to treatment failure showed that the median rate of positive margins after cervical excisional treatment was 24% \u003csup\u003e[4]\u003c/sup\u003e, with cone margin positivity rates exceeding 40% in nine studies. The individualized design of LEEP surgery implemented in this study achieved an endocervical margin positivity rate of 13.25%,which is lower than the reported average levels, indicating that individualized LEEP surgical design is a feasible approach.\u003c/p\u003e\n\u003cp\u003eThis study found that factors affecting the endocervical margins of specimens mainly include preoperative cervical cytology, the number of quadrants affected by aceticacid epithelium under colposcopy, and the preoperative biopsy lesion grade. The more quadrants involved under colposcopy and a higher severity of lesions, the higher the rate of positive endocervical margins after cone excision. Similar conclusions were reached in studies by Chumnan Kietpeerakool \u003csup\u003e[4]\u003c/sup\u003e, Jun-yu Chen\u003csup\u003e[5]\u003c/sup\u003e, Renata B Sim\u0026otilde;es \u003csup\u003e[6]\u003c/sup\u003e. Therefore, for patients with large and high-grade lesions, a sufficiently large surgical range should be designed. These procedures not only have a higher rate of positive margins but also may conceal higher-grade lesions.\u003c/p\u003e\n\u003cp\u003eCurrently, postoperative HPV testing is considered the most accurate predictor of residual/recurrence in patients with HSILof cervix\u003csup\u003e[7,8]\u003c/sup\u003e,which has a much higher predictive ability for CIN2\u0026thinsp;+\u0026thinsp;lesion residual/reccurence (91%) and a negative predictive value of 100%\u003csup\u003e[9]\u003c/sup\u003e.In contrast, positive surgical margins in postoperative samples can only predict about 56% of lesion residual/recurrence. At the same time, Kucera et al. believe that effective treatment for pre-cancerous cervical lesions requires not only lesion removal but also eradication of HPV infection \u003csup\u003e[10]\u003c/sup\u003e. Therefore, this study chose postoperative HPV testing results as an alternative indicator for measuring disease prognosis. HPV persistence was defined as the presence of the same HPV type before surgery and at the first follow-up visit after surgery(generally at 6 months after the surgery)\u003csup\u003e[11\u0026ndash;13]\u003c/sup\u003e.This study showed that the rate of persistent HPV infection at 2 years after LEEP surgery was 15.23%. The follow-up HPV testing conducted at 6 months, 6\u0026ndash;12 months, and 12\u0026ndash;24 months after surgery showed no statistically significant difference in the rate of persistent infection between the positive and negative endocervial margins groups. These results suggest that positive endocervial margins did not increase the risk of postoperative HPV persistent infection.A cohort study of 1029 patients also arrived at the same conclusion \u003csup\u003e[12]\u003c/sup\u003e. Furthermore, some studies have indicated that there is a significant increase in HPV persistence rates among positive margin patients compared to negative margin ones within the first six months after surgery. However, this difference disappears after 3\u0026ndash;5 years of follow-up \u003csup\u003e[14]\u003c/sup\u003e.Current reports on postoperative HPV persistence rates vary significantly due to the differences in patient characteristics and follow-up time points across studies.Yung-Taek Ouh et al. found that the rate of postoperative persistent HPV infection was approximately 38.7% at 6 months after surgery. Among those with persistent infection, about 9.7% were confirmed to have residual lesions \u003csup\u003e[15]\u003c/sup\u003e.Yutaka Nagai et al. detected that CIN3 patients who underwent cone biopsy had an average follow-up of 31.8 months, and the rate of persistent HPV infection was approximately 19.6%. There are about 45.5% experienced lesion recurrence among them \u003csup\u003e[16]\u003c/sup\u003e. Some studies also suggest that the rate of persistent HPV infection among negative-margin patients was 45.5% at 3 months after surgery, but decreased to 14.3% at 6 months after surgery\u003csup\u003e[17]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThere are 85.6% of the patients in this study had TZ3-type lesions ,but they underwent individualized LEEP treatment plans which are different with traditional cervical conization, The results showed that LEEP with cone lengths of \u0026le;\u0026thinsp;1cm, 1-1.5cm, and 1.5-2.0cm could remove approximately 58.9%, 80.1%, and 86.8% of the lesions, respectively. After a 2-year follow-up, the residual lesion rate was only 4.6%, which was lower than the reported residual/recurrence rates of 5\u0026ndash;15% after LEEP \u003csup\u003e[18]\u003c/sup\u003e. This suggests that individualized LEEP design not only removes less tissue but also does not affect disease prognosis. One possible reason is related to full electrosurgical coagulation of the margin after cutting, which not only stops bleeding but also destroys any remaining lesions. On the other hand, tissue repair after LEEP surgery can mobilize local immune function to clear the virus. But the effects of these two procedures are difficult to measure with objective standards.There are also relevant reports, such as the study by Theresa Maria Kolben et al., which suggests that compared with traditional cone excision, only removing the lesion site may have higher rates of positive margins but does not reduce HPV clearance rates and results in a smaller volume of cervical tissue removed \u003csup\u003e[19]\u003c/sup\u003e. Another study on cervical HPV-infected women undergoing 5\u0026ndash;8 mm-deep cone excision found significant differences in HPV clearance rates at 6 and 12 months after surgery compared to the untreated group. This study believes that LEEP surgery itself can accelerate HPV clearance \u003csup\u003e[20]\u003c/sup\u003e. Of course, there are completely different views. The study by Ghaem-Maghami et al. found that the postoperative HSIL detection rate was 3% and 18% for patients with negative margins and positive/uncertain margins, respectively. They believe that cone excision should strive to remove lesions as cleanly as possible to achieve negative margins \u003csup\u003e[2]\u003c/sup\u003e. Therefore, there has been ongoing discussion regarding the depth of individualized cervical conization procedures.Some studies suggest that about 86% of CIN3 lesions are shorter than 10mm, and even lesions confined to the cervix are generally difficult to extend beyond 22mm above the cervix external os \u003csup\u003e[21]\u003c/sup\u003e. Kliemann et al. found that when the depth of cone excision reaches 11mm, 13mm, and 20mm, approximately 90%, 95%, and 100% of CIN2-3 lesions can be removed, respectively\u003csup\u003e[22]\u003c/sup\u003e, supporting the feasibility of our approach.Some studies suggest that to achieve a negative margin, lesions in women under 40 years old with CIN2 or CIN3\u0026thinsp;+\u0026thinsp;require a minimum depth of excision of 0.9cm and 1.8cm, respectively. For women between 40\u0026ndash;50 years old, the minimum depth of excision for CIN2 and CIN3\u0026thinsp;+\u0026thinsp;lesions is 1.2cm and 1.8cm\u003csup\u003e[23]\u003c/sup\u003e. These study results indicate that most patients do not need to be cut too deeply.However, in the opinion of the author, individualized surgical excision combined with full electrosurgical coagulation can avoid excessive removal of cervical tissue and does not affect the prognosis of the lesion for women with fertility requirements, meanwhile reducing the risk of adverse pregnancy outcomes ,which will be a feasible and effective treatment method.\u003c/p\u003e\n\u003cp\u003eThis study did not find any correlation between age, endocervical margin status, surgical design, and postoperative HPV clearance. It is possible that this is due to the fact that all surgeries were performed in the outpatient setting, with the vast majority being women of childbearing age. Therefore, additional case data from other age groups needs to be added in the future to obtain more comprehensive and objective conclusions.\u003c/p\u003e\n\u003cp\u003eThe advantages of individualized LEEP surgical design should not only include the evaluation of its effects on margin status, disease prognosis, and postoperative cervical morphology but also focus on the assessment of subsequent fertility and pregnancy outcomes for women with fertility requirements. Unfortunately, as for now, not all 68 female patients' pregnancy outcomes have been followed up. Some patients are seeking assisted reproduction, and whether this is related to the surgery still needs further follow-up and data collection.\u003c/p\u003e\n\u003cp\u003eIn conclusion, this study suggests that an individualized cervical LEEP surgical design, which prioritizes patients' fertility requirements, and based on comprehensive and precise assessments using colposcopy, is a safe, effective, and feasible approach. This conforms to the trend of precision medicine and offers greater benefits for women with fertility requirements.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eT. L. and H.L.: Conceptualization, Methodology, Data curation, Writing - original draft. X. L.: Review \u0026amp; Editing. G. H.: Data curation. W. W.: Formal analysis. B. M.: Data Curation. Y. Z.: Formal Analysis. T. L.: Review \u0026amp; Editing, Validation.\u003c/p\u003e\n\u003ch2\u003eDeclaration of Competing Interest\u003c/h2\u003e \u003cp\u003eThe authors made no disclosures. No specific funding was disclosed.\u003c/p\u003e "},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRivoire WA, Monego HI, Dos Reis R, Binda MA, Magno V, Tavares EB, et al. Comparison of loop electrosurgical conization with one or two passes in high-grade cervical intraepithelial neoplasias. Gynecol Obstet Invest. 2009;67(4):228\u0026ndash;35. https://doi.org/10.1159/000209214 PMID: 19293589\u003c/li\u003e\n\u003cli\u003eGhaem-Maghami S, Sagi S, Majeed G, Soutter WP. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. The Lancet Oncology. 2007 Nov 1;8(11):985\u0026ndash;93. https://doi.org/10.1016/S1470-2045(07)70283-8\u003c/li\u003e\n\u003cli\u003eOliveira CA de, Russomano FB, Gomes J\u0026uacute;nior SC dos S, Corr\u0026ecirc;a F de M. Risk of persistent high-grade squamous intraepithelial lesion after electrosurgical excisional treatment with positive margins: a meta-analysis. Sao Paulo Med J. 2012;130(2):119\u0026ndash;25. https://doi.org/10.1590/s1516-31802012000200009 PMID: 22481759\u003c/li\u003e\n\u003cli\u003eKietpeerakool C, Khunamornpong S, Srisomboon J, Siriaunkgul S, Suprasert P. Cervical intraepithelial neoplasia II-III with endocervical cone margin involvement after cervical loop conization: is there any predictor for residual disease? J Obstet Gynaecol Res. 2007 Oct;33(5):660\u0026ndash;4. https://doi.org/10.1111/j.1447-0756.2007.00628.x PMID: 17845326\u003c/li\u003e\n\u003cli\u003eChen J-Y, Wang Z-L, Wang Z-Y, Yang X-S. The risk factors of residual lesions and recurrence of the high-grade cervical intraepithelial lesions (HSIL) patients with positive-margin after conization. Medicine (Baltimore). 2018 Oct;97(41):e12792. https://doi.org/10.1097/MD.0000000000012792 PMID: 30313104\u003c/li\u003e\n\u003cli\u003eSim\u0026otilde;es RB, Campaner AB. Post-cervical conization outcomes in patients with high-grade intraepithelial lesions. APMIS. 2013 Dec;121(12):1153\u0026ndash;61. https://doi.org/10.1111/apm.12064 PMID: 23607318\u003c/li\u003e\n\u003cli\u003eArbyn M, Ronco G, Anttila A, Meijer CJLM, Poljak M, Ogilvie G, et al. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine. 2012 Nov 20;30 Suppl 5:F88-99. https://doi.org/10.1016/j.vaccine.2012.06.095 PMID: 23199969\u003c/li\u003e\n\u003cli\u003eSmart OC, Sykes P, Macnab H, Jennings L. Testing for high risk human papilloma virus in the initial follow-up of women treated for high-grade squamous intraepithelial lesions. Aust N Z J Obstet Gynaecol. 2010 Apr;50(2):164\u0026ndash;7. https://doi.org/10.1111/j.1479-828X.2009.01132.x PMID: 20522074\u003c/li\u003e\n\u003cli\u003eHeymans J, Benoy IH, Poppe W, Depuydt CE. Type-specific HPV geno-typing improves detection of recurrent high-grade cervical neoplasia after conisation. Int J Cancer. 2011 Aug 15;129(4):903\u0026ndash;9. https://doi.org/10.1002/ijc.25745 PMID: 21064091\u003c/li\u003e\n\u003cli\u003eKucera E, Sliutz G, Czerwenka K, Breitenecker G, Leodolter S, Reinthaller A. Is high-risk human papillomavirus infection associated with cervical intraepithelial neoplasia eliminated after conization by large-loop excision of the transformation zone? Eur J Obstet Gynecol Reprod Biol. 2001 Dec 10;100(1):72\u0026ndash;6. https://doi.org/10.1016/s0301-2115(01)00457-2 PMID: 11728661\u003c/li\u003e\n\u003cli\u003eBogani G, Pinelli C, Chiappa V, Martinelli F, Lopez S, Ditto A, et al. Age-specific predictors of cervical dysplasia recurrence after primary conization: analysis of 3,212 women. J Gynecol Oncol. 2020 Sep;31(5):e60. https://doi.org/10.3802/jgo.2020.31.e60 PMID: 32808492\u003c/li\u003e\n\u003cli\u003eOuh Y-T, Cho HW, Kim SM, Min K-J, Lee S-H, Song J-Y, et al. Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment. Obstet Gynecol Sci. 2020 Sep;63(5):631\u0026ndash;42. https://doi.org/10.5468/ogs.20049 PMID: 32693443\u003c/li\u003e\n\u003cli\u003eHoffman SR, Le T, Lockhart A, Sanusi A, Dal Santo L, Davis M, et al. Patterns of persistent HPV infection after treatment for cervical intraepithelial neoplasia (CIN): A systematic review. Int J Cancer. 2017 Jul 1;141(1):8\u0026ndash;23. https://doi.org/10.1002/ijc.30623 PMID: 28124442\u003c/li\u003e\n\u003cli\u003eRizzuto I, Nalam M, Jiang J, Linder A, Rufford B. Risk factors for HPV persistence and cytology anomalies at follow-up after treatment for cervical dysplasia. Int J Gynaecol Obstet. 2018 May;141(2):240\u0026ndash;4. https://doi.org/10.1002/ijgo.12431 PMID: 29250779\u003c/li\u003e\n\u003cli\u003eOuh Y-T, Cho HW, Kim SM, Min K-J, Lee S-H, Song J-Y, et al. Risk factors for type-specific persistence of high-risk human papillomavirus and residual/recurrent cervical intraepithelial neoplasia after surgical treatment. Obstet Gynecol Sci. 2020 Sep;63(5):631\u0026ndash;42. https://doi.org/10.5468/ogs.20049 PMID: 32693443\u003c/li\u003e\n\u003cli\u003eNagai Y, Maehama T, Asato T, Kanazawa K. Persistence of human papillomavirus infection after therapeutic conization for CIN 3: is it an alarm for disease recurrence? Gynecol Oncol. 2000 Nov;79(2):294\u0026ndash;9. https://doi.org/10.1006/gyno.2000.5952 PMID: 11063660\u003c/li\u003e\n\u003cli\u003eKim Y-T, Lee JM, Hur S-Y, Cho C-H, Kim YT, Kim SC, et al. Clearance of human papillomavirus infection after successful conization in patients with cervical intraepithelial neoplasia. Int J Cancer. 2010 Apr 15;126(8):1903\u0026ndash;9. https://doi.org/10.1002/ijc.24794 PMID: 19642095\u003c/li\u003e\n\u003cli\u003eAng C, Mukhopadhyay A, Burnley C, Faulkner K, Cross P, Martin-Hirsch P, et al. Histological recurrence and depth of loop treatment of the cervix in women of reproductive age: incomplete excision versus adverse pregnancy outcome. BJOG. 2011 May;118(6):685\u0026ndash;92. https://doi.org/10.1111/j.1471-0528.2011.02929.x PMID: 21429068\u003c/li\u003e\n\u003cli\u003eKolben TM, Etzel LT, Bergauer F, Hagemann I, Hillemanns P, Repper M, et al. A randomized trial comparing limited-excision conisation to Large Loop Excision of the Transformation Zone (LLETZ) in cervical dysplasia patients. J Gynecol Oncol. 2019 May;30(3):e42. https://doi.org/10.3802/jgo.2019.30.e42 PMID: 30887760\u003c/li\u003e\n\u003cli\u003eZhang W, Gong X, Wu Q, Liu Y, Lao G, Xiao J, et al. The Clearance of High-Risk Human Papillomavirus is Sooner After Thin Loop Electrosurgical Excision Procedure (t-LEEP). J Invest Surg. 2019 Sep;32(6):560\u0026ndash;5. https://doi.org/10.1080/08941939.2018.1483449 PMID: 30212232\u003c/li\u003e\n\u003cli\u003eIndman PD. Modern Colposcopy: Textbook and Atlas (Third Edition). Journal of Minimally Invasive Gynecology. 2012 Jul 1;19(4):538. https://doi.org/10.1016/j.jmig.2012.03.002\u003c/li\u003e\n\u003cli\u003eKliemann LM, Silva M, Reinheimer M, Rivoire WA, Capp E, Dos Reis R. Minimal cold knife conization height for high-grade cervical squamous intraepithelial lesion treatment. Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):342\u0026ndash;6. https://doi.org/10.1016/j.ejogrb.2012.08.016 PMID: 22948133\u003c/li\u003e\n\u003cli\u003eBae HS, Chung YW, Kim T, Lee KW, Song JY. The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity. Acta Obstet Gynecol Scand. 2013 Feb;92(2):185\u0026ndash;92. https://doi.org/10.1111/aogs.12025 PMID: 23034067\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"high-grade squamous intraepithelial lesion, human papillomavirus, LEEP, endocervical margin, transformation zone","lastPublishedDoi":"10.21203/rs.3.rs-3973268/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3973268/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThis study aimed to explore the relationship between individualized design of cervical loop electrosurgical excision procedure (LEEP ) and endocervical margin status as well as prognosis of cervical lesions.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 151 outpatients dignosed with cervical high-grade squamous intraepithelial lesion(HSIL)in Guangdong Women and Children Hospital from January 2015 to December 2019 were included in this study. From the perspective of a patient's fertility requirments, the colposcopist conducted individualized LEEP with them. The pathologic features of the endocervical margins, presence of cervical stenosis or adhesion, and HPV test results within 2 years after the surgery were documented.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e1.Endocervical margin positive rate of LEEP is13.25%(20/151). There were significant differences observed in design of LEEP between the patients with different reproductive requirements, although no statistically difference was detected in endocervical margin positivity rates (P\u0026thinsp;=\u0026thinsp;0.979)with them.2.Univariate logistic regression analysis revealed that cervical cytology (P\u0026thinsp;=\u0026thinsp;0.040), the number of quadrants involved by acetowhite epithelium (P\u0026thinsp;=\u0026thinsp;0.032), and lesion grade of biopsy (P\u0026thinsp;=\u0026thinsp;0.028) were significantly associated with endocervical margin .Multivariate logistic regression analysis revealed that quadrants involved by acetowhite epithelium (P\u0026thinsp;=\u0026thinsp;0.034) and the grade of biopsy(P\u0026thinsp;=\u0026thinsp;0.020)were independent risk factors for positive endocervical margin. 3.HPV clearance rate is 84.77% in 2 years after surgery.There are no significant differences with different endocervical margin status and HPV recheck results (\u0026le;\u0026thinsp;6 months, 7\u0026ndash;12 months, and 12-24months) (P\u0026thinsp;=\u0026thinsp;1.000, 0.984, 0.382);4.Approximately 58.9%, 80.1%, and 86.8% of lesions can be removed with cone lengths\u0026thinsp;\u0026le;\u0026thinsp;1cm,\u0026le;1.5cm, and \u0026le;\u0026thinsp;2.0cm, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIndividualized LEEP surgical design is feasible and effective in clinical practice.Women with fertility requirements will benefit even more.\u003c/p\u003e","manuscriptTitle":"The impact of individualized design of cervical LEEP surgery on endocervical margin status and disease prognosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-26 13:36:44","doi":"10.21203/rs.3.rs-3973268/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6b09e5c9-ffc4-4b89-af99-67aea254b817","owner":[],"postedDate":"February 26th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-03-19T08:13:25+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-26 13:36:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3973268","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3973268","identity":"rs-3973268","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}