Appropriate Cone Dimensions to Achieve Negative Excision Margins after Large Loop Excision of Transformation Zone in the Uterine Cervix for Cervical Intraepithelial Neoplasia

Abstract

Aims: To determine appropriate cone dimensions for predicting margin status after large loop excision of transformation zone (LLETZ) treatment. Methods: An observational study performed at the Colposcopy Unit of a university hospital setting involving patients who underwent LLETZ conisation within a 1-year period. Data concerning the characteristics, cone dimensions, lesion grade and excision margins of the patients were recorded. Results: The median age of the women (n = 61) was 38 years (18-53). LLETZ cone specimens had 36.1% of cervical intraepithelial neoplasia (CIN)2/3 lesion and 13.1% positive margins. Mean cone depth and volume were 10.9 mm and 2.3 cm³, respectively. Multiple logistic regression for main predictors and after adjustment for age, parity and CIN severity showed that cone volume and length, cone base surface and proportion of excised volume had a significant effect on margin positivity. ROC analysis showed that optimal cut-off for cone volume was 2.1 cm³ (87.5% sensitivity - 54.7% specificity) or 8.6% of initial cervical volume (75% sensitivity - 75.5% specificity), and for cone length it was 10 mm (100% sensitivity - 52.8% specificity). Optimal cut-off for cone base surface as percentage of ectocervical surface was 32.7% (75% sensitivity - 69.8% specificity). Conclusions: These findings should be taken into consideration when planning the outer boundaries of excision and cervical tissue to be removed so as to achieve oncologically safe limits.

Optimal cone size to predict positive surgical margins after cold knife conization (CKC) and the risk factors for residual disease

“…Papoutsis et al (13) reported that the optimal cut-off value of cone depth to achieve clear surgical margins is 10 mm; however, Kliemann et al (2) showed that the mean depth of cone specimens were 17.1 mm and 22.4 mm among the patients with positive and negative surgical margins, respectively. We found that cone depth was significantly different between margin-positive and margin-negative patients, but multivariate analysis showed that cone depth alone was not an independent predictor of margin status.…”

The Overtreatment Risk of See-and-Treat Strategy in Management of Abnormal Cervical Cytology

“…Conization was performed using a diathermal electrocauterizer, which uses high-frequency waves [12]. The pathologic analysis was performed by the pathologists at the same institution.…”

Pregnancy Outcome after the Treatment of Loop Electrosurgical Excision Procedure or Cold-Knife Conization for Cervical Intraepithelial Neoplasia

“…As to CKC, cervical lesions were removed with a cryoscalpel, the excisional extent and depth can be controlled, and there is no electrocauterization damage to surrounding tissue. It has already been acknowledged that the specimens obtained by LEEP are significantly smaller and contain less of the cervical canal and thus less healthy tissue than cones obtained by CKC [12,13]. …”