LEEP excision depth is not independently associated with margin positivity or recorded postoperative hrHPV positivity in women with CIN2/3: a retrospective cohort study

Objective To examine the relationship between loop electrosurgical excision procedure (LEEP) excision depth and both margin status and postoperative high-risk human papillomavirus (hrHPV) positivity in women treated for cervical intraepithelial neoplasia grades 2–3 (CIN2/3), and to identify clinical factors associated with these outcomes. Methods We conducted a retrospective cohort study using deidentified institutional clinical and pathology records from Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University). Pathology-recorded LEEP excision depth was evaluated as a continuous variable per 3-mm increment. The primary outcome was positive versus negative excision margin status, and the secondary outcome was recorded postoperative hrHPV positivity. Multivariable logistic regression models were adjusted for age, CIN grade, and preoperative HPV16/18 status. The robustness of the findings was further examined using nonlinear modeling, alternative margin definitions, inverse-probability-of-observation weighting, and interaction analyses. Because postoperative hrHPV testing was non-standardized and outcome data were substantially incomplete, these limitations should be considered when interpreting the findings of the present retrospective investigation. Results Among 1, 363 unique patient candidates, 488 had complete data for the core exposure and covariates. The primary margin analysis included 422 women, of whom 41 (9.7%) had positive margins, while the postoperative hrHPV analysis included 275 women, of whom 61 (22.2%) had positive results. There was no clear evidence of an independent association between excision depth and either margin positivity (adjusted odds ratio [OR] per 3 mm, 0.95; 95% CI, 0.72–1.26; P = 0.74) or recorded postoperative hrHPV positivity (adjusted OR, 0.80; 95% CI, 0.57–1.13; P = 0. 20). In contrast, CIN3 was strongly associated with positive margins (adjusted OR, 3.74; 95% CI, 1.90–7.34; P < 0. 001), and increasing age was associated with recorded postoperative hrHPV positivity (adjusted OR per 10 years, 1.66; 95% CI, 1.24–2.21; P < 0. 001). Findings remained consistent across nonlinear, weighted, and alternative-specification analyses. Conclusion In this cohort with a relatively narrow range of pathology - recorded excision depths, LEEP excision depth provided limited independent statistical information regarding margin positivity and recorded postoperative hrHPV positivity in women with CIN2/3. Histopathologic grade and patient age showed more consistent associations with these outcomes. Within the constraints of this retrospective cohort, these findings do not support reliance on excision depth alone as a marker of treatment adequacy and instead highlight the importance of integrating lesion characteristics, patient-level factors, margin assessment and postoperative HPV surveillance in clinical practice.