The impact of individualized design of cervical LEEP surgery on endocervical margin status and disease prognosis

Abstract

Abstract Aim This study aimed to explore the relationship between individualized design of cervical loop electrosurgical excision procedure (LEEP ) and endocervical margin status as well as prognosis of cervical lesions. Methods A total of 151 outpatients dignosed with cervical high-grade squamous intraepithelial lesion(HSIL)in Guangdong Women and Children Hospital from January 2015 to December 2019 were included in this study. From the perspective of a patient's fertility requirments, the colposcopist conducted individualized LEEP with them. The pathologic features of the endocervical margins, presence of cervical stenosis or adhesion, and HPV test results within 2 years after the surgery were documented. Results 1.Endocervical margin positive rate of LEEP is13.25%(20/151). There were significant differences observed in design of LEEP between the patients with different reproductive requirements, although no statistically difference was detected in endocervical margin positivity rates (P = 0.979)with them.2.Univariate logistic regression analysis revealed that cervical cytology (P = 0.040), the number of quadrants involved by acetowhite epithelium (P = 0.032), and lesion grade of biopsy (P = 0.028) were significantly associated with endocervical margin .Multivariate logistic regression analysis revealed that quadrants involved by acetowhite epithelium (P = 0.034) and the grade of biopsy(P = 0.020)were independent risk factors for positive endocervical margin. 3.HPV clearance rate is 84.77% in 2 years after surgery.There are no significant differences with different endocervical margin status and HPV recheck results (≤ 6 months, 7–12 months, and 12-24months) (P = 1.000, 0.984, 0.382);4.Approximately 58.9%, 80.1%, and 86.8% of lesions can be removed with cone lengths ≤ 1cm,≤1.5cm, and ≤ 2.0cm, respectively. Conclusion Individualized LEEP surgical design is feasible and effective in clinical practice.Women with fertility requirements will benefit even more.