BACKGROUND: This study was conducted to identify the risk of residual or recurrent high-grade squamous intraepithelial lesions or worse (HSIL+) in patients with successful conization and to develop a customized management strategy.
METHODS: This retrospective study included 939 patients who underwent cold knife conization (CKC) for cervical intraepithelial neoplasia 3 at a hospital in China between January 1, 2013 and December 31, 2020. Demographic characteristics and test results were obtained before and 6, 12, and 24���months after CKC and annually thereafter. Human papillomavirus (HPV) persistence was defined as HPV positive at both 6 and 12���months after CKC, and the primary endpoint was residual or recurrent HSIL+ after CKC.
RESULTS: The mean follow-up period was 68.8���months. In total, 61 (6.5%) patients had HPV persistence, and 19 (2.0%) had residual or recurrent HSIL+. The risk of residual or recurrent HSIL+ was increased in patients with HPV infection at 6���months (hazard ratio [HR], 84.6; 95% confidence interval [CI], 11.2-641) and 12���months (HR, 214; 95% CI, 28.1-1625) after CKC, and HPV persistence after CKC (HR, 244; 95% CI, 32.2-1854). Comparing two different colposcopic referral criteria for HPV persistence and HPV positive 6���months post-CKC, substantially fewer colposcopies were performed per case of residual or recurrent HSIL+ detected in patients with HPV persistence after CKC (3.39 vs. 8.28).
CONCLUSIONS: The risk of residual or recurrent HSIL+ was higher in patients with HPV persistence after CKC. In patients with negative margins, extending the follow-up interval to 12���months may reduce the number of HPV tests and colposcopy referral rates while maintaining HSIL+ detection.
Humans
Female
Retrospective Studies
Conization
Uterine Cervical Dysplasia
Adult
Uterine Cervical Neoplasms
Middle Aged
Follow-Up Studies
Papillomavirus Infections
Neoplasm Recurrence, Local
China
Time Factors
Cryosurgery
