Background and purpose: Repeat conization is a conservative surgical choice for the treatment failure after primary conization in patients with cervical intraepithelial neoplasia (CIN)

however

there were limited evidences to show its efficacy and safety. The aim of the present study was to evaluate the treatment and diagnostic value of repeat conization in the management of residual or recurrent CIN. Methods: From 2003 to 2010

65 CIN patients underwent repeat conization for positive margin

persistent or recurrent disease after primary conization in Fudan University Shanghai Cancer Center. The medical records and pathological slides were reviewed on histopathological outcomes

margin involvement

complications during and after repeat conization

and reappearance of CIN lesions during follow-up

as well as obstetric outcomes. Results: Among the 50 patients for the treatment of positive margin after primary conization

invasive carcinoma was confirmed in 2(4.0%) patients (1 adenocarcinoma and 1 microinvasive squamous carcinoma)

and residual CIN lesions were present in 23 patients (46.0%). In the rest 15 cases for the treatment of persistent or recurrent disease after primary conization

11(73.3%) patients had CIN lesions in the cone specimens

none had invasive carcinoma. After the secondary conization

58 patients had clear margins. Involvement of the ectocervical or endocervical margins was found in 1 adenocarcinoma case and 6 CIN cases. Additional hysterectomy was carried out in the adenocarcinoma case

3 cases with positive margin and 1 case with cervical occlusion and amenorrhea because of cervical adhesion. Massive hemorrhage was another severe complication and occurred in 2 cases. In the 60 cases who preserved their uteruses after secondary conization

reappearance of CIN disease was documented in 4 (6.7%) cases during the median follow-up of 41 months (25-87). Conclusion: Repeat conization appears to be a rational treatment choice for young patients with residual

persistent

recurrent CIN. Invasive carcinoma could be revealed in the repeat conization. Severe complication was uncommon

but needs active management.