Management of patients with positive margin after conization for high‐grade cervical intraepithelial lesions

• Published in: Lasers in surgery and medicine 2022-10, Vol.54 (8), p.1099-1106
• Main Authors: Zhang, Yingcui, Su, Yuehui, Tang, Yujie, Qin, Lihong, Shen, Yan, Wang, Bingjie, Zhou, Yingying, Zhang, Mengzhen, Zhang, Ting
• Format: Article
• Language: English
• Subjects: 5‐aminolevulinic acid photodynamic therapy; Aminolevulinic acid; Effectiveness; Health risks; Health services; high‐grade cervical intraepithelial lesions; Human papillomavirus; Lesions; Management methods; Patients; Photodynamic therapy; positive margin
• ISSN: 0196-8092; 1096-9101
• DOI: 10.1002/lsm.23585

Background and Objective To evaluate the clinical efficacy and safety of 5‐aminolevulinic acid photodynamic therapy (ALA‐PDT) in the treatment of patients with positive margin in comparison to regular follow‐up, and a repeat cervical conization. Materials and Methods A retrospective analysis was conducted using 83 patients with pathologically confirmed high‐grade cervical intraepithelial neoplasia (CIN) with a positive margin after conization. The management methods and patient prognosis were analyzed and compared. Results Thirty‐five, 33, and 15 patients were treated for regular follow‐up, ALA‐PDT, and a repeat cervical conization, respectively. About 33.3% (5/15) patients had residual lesions of low‐grade CIN and above after recognization. The clinical characteristics of patients in the three groups were similar. The residual lesion rates of patients selected for follow‐up, ALA‐PDT, and recognization were 34.3% (12/35), 9.1% (3/33), and 0% (0/15), respectively, at 6‐month follow‐up (p = 0.004). The HPV clearance rates were 31.3%, 66.7%, and 84.6%, respectively (p = 0.01). Further analysis showed that a positive margin in the inscribed margin of the cervical canal (p = 0.022) and persistent HR‐HPV positive tests after initial conization (p = 0.003) significantly increased the risk of residual disease. At 2‐year follow‐up, the recurrence rates of lesions were 3.3% and 26.1% in the ALA‐PDT and follow‐up groups, respectively (p = 0.021). Notably, the recurrence rates were not significantly different between the ALA‐PDT and recognization groups (3.3% vs. 6.7%) (p = 0.561). Conclusion ALA‐PDT is an effective treatment for patients with a positive margin after cervical conization for high‐grade CIN. Compared with regular follow‐up, ALA‐PDT can reduce residual and recurrence rate. Moreover, there was no significant difference in the efficacy between AlA‐PDT and recognization.