Risk factors predicting residual lesion in subsequent hysterectomy following cold knife conization(CKC) for high-grade squamous intraepithelial lesion(HSIL)

Objective: To determine risk factors predicting residual lesion in a subsequent hysterectomy follow a cold knife conization (CKC) for high-grade squamous intraepithelial lesion(HSIL). Method Between January 2010 and December 2021, a total of 740 patients who underwent a hysterectomy within 3 months after CKC for HSIL were included in this study. We analyzed their demographic features and pathological parameters. A logistic regression model was used to analyze the relationship between parameters and residual lesion in subsequent hysterectomy specimens. Results 104 (14.1%) had residual lesion in the hysterectomy specimen, HSIL in 101 patients, 3 patients with microinvasive carcinoma which were positive combine margin. The rate of residual lesion in patients with positive endocervical margin was 31.3%, with positive ectocervical margin was 15.3%, with positive combine margin was 38.6%. In multivariate analysis, positive margin (OR,4.015; 95%CI,2.526–6.381; P < 0.001), glandular involvement (OR,3.484; 95%CI, 1.457–8.330; P = 0.005), HPV16/18 infection(OR,2.804; 95%CI, 1.705–4.611; P < 0.001) and multiple HR-HPV infection (P = 0.019, OR,1.813; 95%CI,1.130–2.909; P < 0.014) were independent risk factors for residual lesions. The AUC calculated by logistic regression model was 0.78. Conclusion positive margin, positive glandular involvement, HPV16/18 and multiple HR-HPV infection were independent high risk factors of residual lesion in a subsequent hysterectomy following CKC for HSIL.