Analysis of Cold-knife Conization Results in HPV Positive Patients

Aim: To perform the retrospective analysis of cases with cold-knife conization operation. We aimed to determine the risk of positive surgical margins in HPV 16/18 positivite and postmenapausal women. Materials and Methods: After approval of the Ethical Commitee, the medical record of patients who had undergone a cold-knife conization surgical procedure in our clinic between January 2015 and July 2017 were reviewed. We included 51 cold-knife conization case that were referred to us for HPV positivity. We have investigated parameters such as age, menopausal status, cervical smear, human papilloma virus (HPV), colposcopic biopsy / conization histopathological evaluation and positive surgical margin. HPV analysis results were grouped as follows to investigate the effect of HPV 16 and 18. Group I: positivity of HPV 16 and / or 18, group II: other high risk (HR) HPV positivite (HPV 16/18 negative). Cold-knife conization results were divided in two groups; normal/low dysplasia group (Normal and CIN I), severe dysplasia group (CIN II / III and CIS). Results: Cervical smear results were as follows; Normal 27 (52.9%), ASCUS 2 (3.9%), LGSIL 14 (27.5%) and HSIL 8 (15.7%). The results of colposcopy were as follows; CIN I 18 (35.3%), CIN II / III 33 (64.7%). Cold-knife conization histopathological results were as follows; 12 (23.5%) normal, 8 (15.7%) CIN I, 23 (45.1%) CIN II / III, 8 (15.7%) CIS. 28 patients were in group I (HPV 16/18 positive), whereas 23 patients were in group II ( other HR-HPV positive). Normal/low dysplasia rate was 35.7% (10/28), severe dysplasia rate was 64.3% (18/28), positive surgical margin rate was 21.4% (6/28) in the group I. And normal/low dysplasia rate was 43.5% (10/23), severe dysplasia rate was 56.5% (13/23), positive surgical margin rate was 8.6% (2/23) in the group II. In generally positive surgical margin rate after cold-knife conization operation was 15.7% (8/51). In postmenopausal patients, more positivite surgical magrin was detected (21.1% - 12.5%). Conclusion: We know that HPV 16 and 18 are more effective than other HR HPVs in the etiopathogenesis of cervical cancer. But there was no significant difference between the groups in terms of severe dysplasia and positive surgical margin. We think that more extensive studies will give clearer results. We also think more emphasis should be given to HR HPVs in routine screening, colposcopy follow-up and vaccination program in this data light