# Perspectives from Hysterectomy Specimens on the Hidden Malignancy Risk in HSIL Patients with Surgical Margin Continuity

## TL;DR

This study shows that some patients with high-grade cervical lesions who have continuous surgical margins may actually have hidden cancer, suggesting the need for careful evaluation and possible hysterectomy.

## Contribution

The study highlights the risk of undetected squamous cell carcinoma in HSIL patients with surgical margin continuity, emphasizing the importance of hysterectomy in such cases.

## Key findings

- 11.8% of patients had squamous cell carcinoma despite initial HSIL diagnosis.
- 34.2% of hysterectomy specimens showed glandular involvement.
- Negative surgical margins were found in all patients post-hysterectomy.

## Abstract

Background and Objectives: We aim to examine the histopathological results following hysterectomy performed due to insufficient cervical tissue in patients diagnosed with high-grade squamous intraepithelial lesions (HSILs) who underwent the loop electrosurgical excision procedure (LEEP) and cold-knife conisation (CKC) and exhibited continuity at the surgical margin and residual disease. Materials and Methods: Thirty-four patients who underwent hysterectomy due to insufficient cervical tissue and had HSILs at the surgical margin were included in this study. The following information was analysed: age, body mass index (BMI), parity, menopausal status (premenopausal/postmenopausal), smoking history, smear result, HPV result, colposcopic cervical biopsy result, transformation zone information, LEEP+Endocervical Curettage (ECC) histopathological result, CKC+ECC histopathological result, hysterectomy material histopathological result, presence or absence of cervical glandular involvement, and presence or absence of residual lesions in the hysterectomy material. Results: The mean (±SD) age of the study cohort was 46.7 ± 8.3 years, the mean BMI was 27.4 ± 2.3 kg/m2, and the mean parity was 2.5 ± 0.7. According to the results of the hysterectomy performed on these 34 patients, in whom Cervical Intraepithelial Neoplasia 3 (CIN3) continuity at the surgical margin and the inability to perform re-excision were determined, 8 patients (23.5%) had CIN2, 19 patients (55.9%) had CIN3, 3 patients (8.8%) had adenocarcinoma in situ, and 4 patients (11.8%) had squamous cell carcinoma (SCC). Histopathological examinations of the hysterectomy specimens revealed negative surgical margins in all patients, while glandular involvement was present in 13 patients (34.2%). Conclusions: It should be borne in mind that patients with HSILs showing continuity at the surgical margin may have an underlying squamous cell carcinoma. These patients should be carefully evaluated for hysterectomy if they do not have sufficient cervical tissue for repeat excisional procedures.