Optimized Management of Positive Margins after Initial LEEP in HSIL Patients

Abstract Objective: Currently, the management of patients with (Loop electrosurgical excision procedure) HSIL who still have positive margins after LEEP surgery is not standardized. This study aims to develop an optimized management plan for patients with HSIL who still have positive margins after LEEP. Methods: We conducted a retrospective review of 61 patients with positive surgical margins following LEEP surgery. We compared the incidence of residual disease or recurrence among these patients after selecting different treatment modalities. Additionally, we performed statistical analyses of the preoperative and postoperative examination results for these patients. Furthermore, we discussed the specific management strategies for patients with positive surgical margins following LEEP surgery. Results: Among patients with positive surgical margins after LEEP surgery, there was no significant difference in the incidence of residual or recurrent lesions between those who underwent surgical treatment and those who opted for conservative treatment (P = 0.172). Among all patients with positive surgical margins after LEEP surgery, positive margins were associated with residual/recurrent disease (P = 0.039). In the conservative treatment group, human papillomavirus (HPV) infection (P = 0.002) and positive cervical cytology test (TCT) results (P = 0.02) were associated with residual/recurrent disease, and positive HPV testing after LEEP surgery was an independent risk factor for residual or recurrent disease (OR, 17.568; 95% CI, 1.551–199.001; P = 0.021). Conclusion: Our research indicates that conservative treatment may be prioritized for patients with positive margins following LEEP surgery.