Objective To investigate the relationship between various loop electrosurgical excision procedure (LEEP) margin status and residual high grade squamous intraepithelial lesion (HSIL) or worse at hysterectomy following conization. Methods The relevant clinicopathological data were collected in the Obstetrics and Gynecology Hospital, Fudan University from Jan. 2014 to Dec. 2015, including 947 cases who underwent hysterectomy within 6 months of LEEP. The residual HSIL or worse at hysterectomy were analyzed among the groups. (1) Clear margins, involved margins, and without 1 mm negative margins. (2) Only one positive margin, two positive margins and three positive margins. (3) A positive margin of internal ostium of cervix, of external ostium of cervix and of the basement. Results (1) The histological evaluation of the uterine specimens showed residual HSIL or worse in 234 cases (24.7％, 234/947). The proportion of residual lesions was 7.3％ (21/286) in population with clear margins, 33.2％ (211/635) with involved margins, 7.7％ (2/26) without 1 mm negative margins, respectively. The positive margins group had significant difference at the aspect of residual rate in contrast to the negative margins group and the without 1 mm negative margins group (P<0.01). Further studies conclusively showed that the proportion of residual lesions was very similar between the negative margins group and the without 1 mm negative margins group (P>0.05). (2) The involved margins were interpretable in 621 cases. This was detected in 25.3％(111/438) patients with only one positive margin, 47.4％(74/156) with two positive margins and 77.8％(21/27) among three positive margins, respectively (P<0.01). (3) Furthermore, there were 418 cases only one positive margin was definite, and the proportion of residual lesions was 31.0％(62/200) in population with a positive margin of internal ostium of cervix, 18.2％(31/170) of external ostium of cervix and 33.3％(16/48) of the basement. The residual rates were higher in the endocervical and basal margin groups than that in the ectocervical margin group, and the differences were significant (P<0.05). Conclusions The risk of residual HSIL or worse is significantly greater with involved margins at hysterectomy following LEEP. Both the positive endocervical and basal margin are excellent predictors of residual diseases, while the without 1 mm negative margin may be not. Clinicians should avoid treating it as positive margin and prevent overtreatment.%目的 探讨子宫颈环形电切术(LEEP)标本的不同切缘状态与全子宫标本中高级别鳞状上皮内病变(HSIL)及以上病变残留的关系.方法 收集2014年1月—2015年12月在复旦大学附属妇产科医院行LEEP且术后6个月内进一步行子宫全切除术的947例患者的临床病理资料进行回顾性分析.(1)根据LEEP标本的切缘状态分为3组,即切缘阳性组、切缘阴性组、切缘距离<1 mm组(指病变与切缘的距离<1 mm),比较3组患者的病变残留率;(2)对LEEP标本受累切缘数量明确(包括一侧、两侧、三侧切缘受累)的患者,进一步比较不同受累切缘数量患者的病变残留率;(3)对LEEP标本一侧切缘阳性且受累切缘类型明确(包括子宫颈颈管侧、外口侧和基底侧切缘受累)的患者,进一步比较不同切缘受累类型患者的病变残留率.结果 (1)947例患者中,全子宫标本中有病变残留者234例,总的病变残留率为24.7％(234/947);其中切缘阳性组、切缘阴性组、切缘距离<1 mm组的病变残留率分别为33.2％(211/635)、7.3％(21/286)、7.7％(2/26),切缘阳性组分别与切缘阴性组、切缘距离<1 mm组比较,差异均有统计学意义(P<0.01);而切缘阴性组、切缘距离<1 mm组比较,差异则无统计学意义(P>0.05).(2)635例LEEP切缘阳性患者中,受累切缘数量明确者621例,其全子宫标本中有病变残留者206例,总的病变残留率为33.2％(206/621);其中一侧、两侧、三侧切缘受累患者的病变残留率分别为25.3％(111/438)、47.4％(74/156)、77.8％(21/27),两两分别比较,差异均有统计学意义(P<0.01).(3)438例LEEP一侧切缘阳性患者中,受累切缘类型明确者418例,其全子宫标本中有病变残留者109例,总的病变残留率为26.1％(109/418);其中子宫颈颈管侧、外口侧和基底侧切缘受累患者的病变残留率分别为31.0％(62/200)、18.2％(31/170)和33.3％(16/48),子宫颈颈管侧、基底侧切缘受累者均明显高于外口侧切缘受累者(P<0.05).结论 子宫颈LEEP切缘阳性是全子宫标本中HSIL及以上病变残留的高危因素,子宫颈颈管侧和基底侧切缘受累均可显著增加病变残留的风险,而病变与切缘的距离<1 mm并不是病变残留的高危因素,临床医师应避免将其视为切缘阳性,防止过度治疗.
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