ObjectiveTo identify the risk factors for residual lesion in hysterectomy specimens after loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia (CIN).Methods and resultsWe retrospectively analyzed the clinical data of 594 patients who underwent total hysterectomy after LEEP for CIN at the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiaotong University between July 2006 and June 2015. Among the 594 patients, there were no residual lesions in uterine specimens of 409 (68.9%) patients; residual CIN1 was found in 24 (4%) patients, CIN2 and CIN3 in 142 (23.9%) patients, and cervical cancer in 19 (3.2%) patients. On univariate analysis age, menopausal status, margin involvement, lesion grade, abnormal endocervical curettage (ECC) result, and persistent human papillomavirus (HPV) infection post operation were significantly associated with residual lesions after LEEP (P < 0.05). Multivariate regression analysis using the logistic regression model showed abnormal ECC result and persistent HPV positivity to be independent risk factors for residual lesions after LEEP. LEEP with positive margins and persistent HPV infection were also associated with high risk of invasive cervical cancer in CIN2+ patients.ConclusionsAbnormal ECC result and post-treatment HPV infection are predictors of residual lesion after LEEP. In combination, they could be useful for risk stratification and selection of the management approach. Postmenopausal CIN2+ patients with positive margins and persistent postoperative HPV infection may have high risk of cervical invasive cancer.

中文翻译：

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CIN患者环形电切术后子宫标本残留病灶

目的探讨子宫颈上皮内瘤变（CIN）环电切除术（LEEP）后子宫切除标本残留病灶的危险因素。方法和结果回顾性分析了国际和平大会上594例因CIN行LEEP后行全子宫切除术的患者的临床资料。 2006年7月至2015年6月上海交通大学附属妇幼保健院。594例患者中，409例（68.9%）患者子宫标本无残留病灶；在 24 名 (4%) 患者中发现残留 CIN1，在 142 名 (23.9%) 患者中发现 CIN2 和 CIN3，在 19 名 (3.2%) 患者中发现宫颈癌。单变量分析年龄、更年期状态、切缘受累、病变分级、宫颈管刮除术 (ECC) 结果异常，手术后持续性人乳头瘤病毒（HPV）感染与 LEEP 术后残留病灶显着相关（P < 0.05）。使用逻辑回归模型的多变量回归分析显示异常ECC结果和持续HPV阳性是LEEP后残留病灶的独立危险因素。切缘阳性的 LEEP 和持续的 HPV 感染也与 CIN2+ 患者发生浸润性宫颈癌的高风险相关。结论异常 ECC 结果和治疗后 HPV 感染是 LEEP 后残留病灶的预测因素。结合起来，它们可用于风险分层和管理方法的选择。切缘阳性且术后持续感染 HPV 的绝经后 CIN2+ 患者可能具有宫颈浸润性癌的高风险。