Is Cone Length a Risk Factor for Internal Margin Positivity in High-Grade Squamous Intraepithelial Lesions Based on Age?

To determine the association between cone length and internal margin positivity in high-grade squamous intraepithelial lesion (HSIL) patients, stratified by age, and provide personalized treatment recommendations. We conducted a retrospective analysis of 1188 HSIL patients treated with Loop Electrosurgical Excision Procedure at the Obstetrics and Gynecology Hospital of Fudan University in 2021. The study evaluated human papillomavirus genotyping, cytology, colposcopy findings, and characteristics of cone excision. Logistic regression analysis was performed to identify independent risk factors associated with internal margin positivity. The overall rate of positive internal margins was 11%. Age (OR 1.03, 95% CI 1.00 to 1.05, p = .021), high-risk cytology (OR 1.69, 95% CI 1.12 to 2.52, p = .012), human papillomavirus 16 infection (OR 1.78, 95% CI 1.18 to 2.66, p = .006), and endocervical HSIL lesion (OR 5.05, 95% CI 3.15 to 8.08, p < .001) were independent risk factors for internal margin positivity. Notably, among women >50, a negative correlation between cone length and positive internal margins was observed. A cone length exceeding 20 mm reduced the positive internal margin rate to 7%. In cases of cervical atrophy, excising at least 50% of the pre-operative cervical length significantly reduced the positive internal margin rate to 12.5%. The length of the excision cone is a significant risk factor for positive internal margin, particularly among women >50. This highlights the importance of age-specific, optimized cervical excision lengths and supports personalized treatment strategies.