Residual disease and risk factors in patients with high-grade cervical intraepithelial neoplasia and positive margins after initial conization

Background: The purpose of this study was to determine the clinicopathologic predictors of residual disease in patients with high-grade cervical intraepithelial neoplasia (CIN) and margin involvement after initial conization. Methods: Data from 145 patients who underwent subsequent surgery for high-grade CIN with positive margins were retrospectively analyzed. Results: After subsequent surgery, residual disease was diagnosed in 47 (34.2%) patients, of whom five had invasive cervical carcinoma, 31 had CIN 3, nine had CIN 2, and two had CIN 1. Multivariate analysis revealed that only age >= 35 years (P=0.033), major abnormal cytology (P=0.002), and pre-cone high-risk human papillomavirus load. 300 relative light units (P=0.011) were significant factors associated with residual disease. Conclusion: Age >= 35 years, major abnormal cytology, and pre-cone high-risk human papillomavirus load >= 300 relative light units were the only significant factors predicting post-cone residual disease. Appropriate application of these predictive factors may avoid delayed treatment and overtreatment.