Residual/recurrent lesions after cold-knife conization for high-grade cervical intraepithelial neoplasia: risk factor analysis and clinical management recommendations.

Objective: This study aims to evaluate the risk factors of residual/recurrent lesions of cervical intraepithelial neoplasia 2/3 (CIN2/3) in patients who underwent cold-knife conization (CKC). Methods: A total of 976 patients with CIN2/3 who were treated with CKC were retrospectively analyzed. Post-CKC follow-up involved a thin-prep cytology test (TCT) and human papillomavirus (HPV) tests. Residual/recurrent lesions after CKC (RLC) were defined as biopsy-proven CIN2/3 during follow-up, whereas residual lesions identified after a hysterectomy (RLH) were defined as lesions in patients who underwent a hysterectomy 1-6 months after CKC and were diagnosed with CIN 2/3, cervical carcinoma Results: During the follow-up period, 152/976 (15.57%) of the patients underwent a hysterectomy and the remaining 824 patients completed their continuous follow-up. Of these, 45/824 (5.46%) were diagnosed with RLC and 53/152 (34.87%) of the patients who underwent a hysterectomy were diagnosed with RLH. RLC was significantly associated with factors such as persistent HPV infection, HPV infection types (preoperative and postoperative), TCT test (6-month postoperative), postoperative margins, and ECC results ( Conclusion: Risk factors associated with RLC and RLH must be considered when implementing targeted clinical interventions. Elongating the clinical follow-up period is of paramount importance, particularly for patients with high-risk factors; therefore, it is recommended that follow-up intervals be reduced. For patients with HPV16/18 infection, positive margins, and positive ECC, it is recommended that a hysterectomy be performed whenever necessary.