Introduction/Background This study aimed to examine whether the intraoperative use of Lugol’s solution reduces the proportion of positive resection margins (RMs) using the data of women who underwent large loop excision of the transformation zone (LLETZ).

Methodology A total of 1,751 consecutive women with cervical intraepithelial neoplasia (CIN) who underwent LLETZ with or without Lugol’s solution were retrospectively retrieved from each database of three university hospitals in South Korea. Outcomes included positive RMs and residual disease pathologically confirmed within 6 months after LLETZ.

Results Positive RMs were noted in 345 (19.7%) cases. Among 1,507 women followed up, residual disease was diagnosed in 100 (6.6%) cases (69/308 cases with positive RMs; 31/1,199 cases with negative RMs). The Lugol’s solution group was less likely to have positive RMs (11.8% vs. 25.5%; P < 0.01), to require additional surgical intervention (5.4% vs. 10.2%; P < 0.01), and to have residual disease (4.9% vs. 8.0%; P = 0.02). On multiple logistic regression analysis, Lugol’s solution reduced the proportion of positive RMs (adjusted odds ratio [aOR], 0.31). Age (50 years or older, aOR, 1.64), pre-conization cervical cytology (aOR, 1.53), high-risk HPV (aOR, 1.75), and CIN 2 or 3 (aOR, 2.65) were independent risk factors for margin positivity (P < 0.01 for all except high-risk HPV of P=0.05).

Conclusion Lugol’s solution optimizes CIN treatment by reducing the proportion of positive RMs and residual disease after LLETZ.

Disclosures All authors have no potential conflicts of interest to disclose.