Can we predict surgical margin positivity while performing cervical excisional procedures?

Durmuş, Yasin; Karalök, Alper; Başaran, Derman; Kamani, Mustafa Onur; Boran, Nurettin; Koç, Sevgi; Turan, Ahmet Taner

doi:10.1080/01443615.2019.1645101

Cited by 7 publications

(15 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Some studies showed that the sensitivity, specificity and positive prediction of TCT were 78.3, 77.9 and 73.3%, respectively, which was higher than the HPV test ( 29 ). In this study, compared with other types of HPV, HPV16/18 infection had no effect on the positive margin, which is consistent with a previous study ( 26 ). However, postoperative TCT with HSIL is a risk factor of positive resection margin.…”

Section: Discussionsupporting

confidence: 93%

“…We also found that age >35 y was a risk factor for positive margins after LEEP surgery (P = 0.033), which is consistent with the previous results (25). Previous studies showed that menopause was a risk factor for positive surgical margins (26,27), and our research also confirmed these findings. The cervix of postmenopausal women atrophies and the squamous column junction moves inward, which increases the difficulty of lesion detection and operation.…”

Section: Discussionsupporting

confidence: 92%

“…The large lesion range increases the operation difficulty of the operator and LEEP is more difficult for the complete resection of large-scale cervical lesions. Some studies have pointed out that the experience and professionalism of doctors are related to the positive rate of surgical margin, and inexperienced surgeons may increase the positive rate of surgical margin ( 26 , 35 ). In our study, all surgeons had been engaged in colposcopy diagnosis and treatment of cervical lesions for many years and had rich clinical experiences and theoretical knowledge to avoid the influence of surgeons on surgical margins.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Zhu

Chen

et al. 2022

Front. Med.

View full text Add to dashboard Cite

IntroductionCurrently, the commonly used surgical methods for cervical lesions include loop electrosurgical excision procedure (LEEP) and cold knife conization (CKC). However, the positive rate of surgical margins after LEEP is relatively high, which leads to disease recurrence and places further demand on clinical treatment. This study investigated factors related to positive margins after LEEP and established a scoring system to enhance preoperative risk assessment and surgical selection.Materials and MethodsA retrospective analysis of the clinical data of 411 patients undergoing LEEP surgery for cervical lesions in the First Affiliated Hospital of University of Science and Technology of China (USTC), from January 2016 to March 2021, was performed. Cases were divided into a negative margin group (349 cases) and a positive margin group according to postoperative pathology. In the positive group (62 cases), single-factor and multi-factor analyses screened influencing factors; a logistic and additive scoring system was established; furthermore, a ROC curve was used to evaluate scoring effectiveness.ResultsThe positive rate of resection margins after LEEP was 15.1%. Univariate analysis indicated a relationship to patient age, menopause, preoperative ThinPrep Cytology Test (TCT) results, lesion quadrant number under colposcopy, cervical biopsy, and the result of endocervical curettage (ECC). Multivariate analysis showed that age >35 y, menopause, preoperative TCT being high-grade squamous intraepithelial lesion (HSIL), four quadrants being involved under colposcopy, and ECC being HSIL were all independent influencing factors of positive margins after LEEP (P < 0.05). These were included with the above factors to establish a logistic and additive scoring system. When the logistic score was 17, the sensitivity and specificity of predicting positive margins after LEEP were 80.6 and 61.6%, respectively. When the additive score was 6, the sensitivity and specificity were 74.2 and 66.2%, respectively. Both scoring systems had good predictability (area under the curve AUC >0.75).ConclusionsThis study quantified factors influencing positive margins after LEEP and established a scoring system for evaluating patients before surgery to provide a basis for individualized treatment and selection of surgical methods.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Zhu

Chen

et al. 2022

Front. Med.

View full text Add to dashboard Cite

show abstract

“…The length, width, and depth were multiplied to calculate the specimen volume. Other studies investigated the optimal size of the specimen to avoid positive margins or recurrence and determined the volume of specimens using the semi‐ellipsoid volume formula (2/3 × π × A × B × C ), where A , B , and C refer to the length of three semi‐axes of the ellipsoid 22–24 . However, these studies failed to find significant associations between the volume of the specimen and recurrence.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for recurrence of cervical intraepithelial neoplasia after loop electrosurgical excisional procedure in patients with positive margins

Lee

Shin

et al. 2023

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim Loop electrosurgical excisional procedure (LEEP) is a major treatment method for cervical precancerous lesions. However, recurrence rates were estimated to be 15%, and the risk is increased if a surgical margin is involved by dysplastic cells. This study aimed to identify the risk factors for recurrence of cervical precancerous lesions in patients with positive margins. Methods We retrospectively reviewed medical records of patients who underwent LEEP between 2012 and 2014 and had a positive surgical margin. Clinicopathologic factors were collected, including age, parity, menopausal status, smoking, human papilloma virus infection, results of cytology/biopsy/LEEP, and specimen size and volume. Results A total of 117 patients with positive margins were included, and 26 (22.2%) patients had recurrence. According to a multivariate analysis, the recurrence rates were significantly higher in parous women (adjusted hazard ratio [HR], 2.92; 95% confidence interval [CI], 1.00–8.49), but positive margins at the exocervix (adjusted HR, 0.39; 95% CI, 0.17–0.91) and volume ≥4000 mm3 (adjusted HR, 0.36; 95% CI, 0.16–0.82) showed negative correlation. Conclusions The risk of recurrence for cervical precancerous lesions increased in patients with a history of previous delivery, positive margin at the endocervix, and specimen volume of LEEP <4000 mm3. These results could help gynecologists determine optimal treatment options for patients with positive margins.

show abstract

“…Patients with MI have a 5-fold higher relative risk of persistent or recurrent CIN II+ lesions than margin-negative patients [ 2 ]. Therefore, repeat conization or hysterectomy is considered appropriate for patients with MI who have no concerns about future fertility [ 22 , 23 , 24 ]. However, unlike MI, there is insufficient evidence for repeat conization or hysterectomy in GI-positive patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Associated with Endocervical Glandular Involvement in Patients with Cervical Intraepithelial Neoplasia III

Kim

Baek

Lee

et al. 2022

JCM

View full text Add to dashboard Cite

This study aimed to determine whether endocervical glandular involvement (GI) affects the clinical prognosis of patients with cervical intraepithelial neoplasia (CIN) III who underwent the loop electrosurgical excision procedure (LEEP). This retrospective study included 250 patients who underwent LEEP for the treatment of CIN III between August 2005 and May 2020. The medical records of 234 patients were analyzed; 137 (58.5%) patients were GI negative, and 97 (41.5%) were GI positive. Margin involvement of the LEEP specimen was found in 59 (45.4%) patients in the GI-negative group and 54 (58.7%) patients in the GI-positive group (p = 0.051). The additional surgical procedures (repeat conization or hysterectomy) were significantly more performed in GI-positive patients than in GI-negative patients (40.9% vs. 23.1%, p = 0.004). When comparing the LEEP specimens of GI-1 (GI-positive confirmed via cervical biopsy before conization) and GI-2 (GI-positive confirmed via conization), we found that the mean depth was significantly greater in the GI-1 group (10.9 mm) than in the GI-2 group (7.6 mm) (p = 0.024). Surgical margin involvement was more frequently observed in the GI-2 group than in the GI-1 group (p = 0.030). There was no significant difference in the recurrence rates of CIN between the GI-negative and GI-positive groups (p = 0.641). In conclusion, despite no significant differences in residual disease and CIN recurrence between the GI-negative and GI-positive groups, additional surgical treatments were more frequently performed in GI-positive patients. Repeat surgery based on GI positivity should be carefully considered to avoid overtreatment and surgical complications.

show abstract

Can we predict surgical margin positivity while performing cervical excisional procedures?

Cited by 7 publications

References 21 publications

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Construction and Evaluation of a Clinical Prediction Scoring System for Positive Cervical Margins Under Colposcopy

Risk factors for recurrence of cervical intraepithelial neoplasia after loop electrosurgical excisional procedure in patients with positive margins

Clinical Outcomes Associated with Endocervical Glandular Involvement in Patients with Cervical Intraepithelial Neoplasia III

Contact Info

Product

Resources

About