Clinical Value of Residual Cervical Biopsy during Cervical Conization: A Comprehensive Analysis

<b>Objective</b> To evaluate the predictive value of concurrent residual cervical biopsy during cervical conization for residual lesions in women with high-grade squamous intraepithelial lesion (HSIL), and to identify risk factors for residual disease and pathological downgrading to guide clinical management. <b>Design</b> Retrospective observational study. <b>Setting</b> Single tertiary obstetrics and gynaecology centre in China (The 970th Hospital of the Joint Logistics Support Force, Yantai, Shandong, China). <b>Population or Sample</b> 108 patients who underwent cold knife conization for HSIL between January 2023 and December 2024. <b>Methods</b> Intraoperative multi-point biopsy of the residual cervix was performed in all cases. Associations between conization margin status, clinicopathological factors, and residual lesions were analysed using logistic regression. <b>Main Outcome Measures</b> Residual lesion rate; independent risk factors for residual disease; pathological downgrading rate and related factors. <b>Results</b> Residual lesions were detected in 22.2% of patients. Positive conization margins were associated with a significantly higher residual positive rate (60.0% vs 7.7%, P<0.001). Independent risk factors for residual disease were age ≥40 years (OR 3.25, 95%CI 1.12–9.43), HPV16/18 infection (OR 4.12, 95%CI 1.45–11.76), and glandular involvement (OR 5.54, 95%CI 1.94–15.85). Pathological downgrading occurred in 25.9% of patients and was associated with age <35 years and biopsy-to-conization interval >8 weeks. <b>Conclusions</b> Intraoperative residual cervical biopsy is safe and feasible for real-time assessment of surgical completeness and detection of occult lesions. Margin status, age, HPV16/18, and glandular involvement reliably stratify residual risk. This strategy supports individualised postoperative care and reduces recurrence risk in women with HSIL.