Endocervical Margins Status in Excision for Preventing Cervical Cancer According to the Transformation Zone Type

Abstract

The aim of this study is to assess the outcomes of 610 excision types I and II in a referral facility as a function of transformation zone (TZ) types.Methods: This is a retrospective cohort study of women with cervical precursor lesions who underwent loop electrocautery excision procedure from 2017 to 2019 at the University of Campinas. The primary outcome was endocervical margin status, negative or positive. Other variables were excision type (I/II), TZ (1/2/3), age, menopausal status, hormonal contraceptives, smoking, and sexual debut. Tests used were chi-square or Fisher exact, Mann-Whitney, and simple and multiple logistic regression. Results:The most frequent was TZ 1 (62.5%). Excision II was the most frequent: 54.1% in TZ 1, 67.2% in TZ 2, and 82.1% in TZ 3. A negative margin was observed in TZ 1, 76.0% when excision I and 86.4% when excision II ( p = .009); TZ 2, 86.4% when excision I and 88.9% when excision II ( p = .672); and TZ 3, 76.5% when excision I and 78.9% when excision II ( p = .672). Multivariate analysis revealed in TZ 1 a 2.12 (1.23-3.65) higher risk of obtaining a negative margin in excision type II. In TZ 2 and 3, none of the variables predicted the chance of a negative margin. Conclusions:The endocervical margin was negative in 3 in every 4 women who underwent loop electrocautery excision procedure, regardless of excision type. Age, menopausal status, smoking, and hormonal contraception did not predict margin status.

Rate of Involved Endocervical Margins According to High-Risk Human Papillomavirus Subtype and Transformation Zone Type in Specimens with Cone Length ≤ 10 mm versus > 10 mm—A Retrospective Analysis

“…Other studies indi-Life 2023, 13, 1775 7 of 11 cate factors like older age, multiparity and disease severity associated with endocervical margin positivity [13,31]. Gertrudes L. et al found that an excision length between 10 and 15 mm was associated with a significantly higher chance (with a calculated OR of 2.01) of obtaining clear endocervical margins in women with a TZ 1, even though the overall rate of clear endocervical margin was observed in three out of four patients regardless of performed excision length [12]. This aligns with our findings demonstrated in Table 2.…”

“…Since an excisional treatment of removing more than 10 mm cervical tissue is known to be an independent risk factor for adverse pregnancy events, we chose to compare two subgroups with a cut-off value of 10 mm to provide data for informed patient education, particularly for women of childbearing age with a desire to get pregnant [ 15 ]. Given the fact that an involved endocervical margin is especially known to be a predictor for treatment failure, i.e., persistent disease, we chose to evaluate only the endocervical margin status [ 12 , 22 ]. Endocervical margin positivity was referred to histological confirmation of HSIL or carcinoma on the surgical margin and designated as “involved” or “clear”.…”

“…Three types of excisional techniques (defined according to the transformation zone (TZ)) were described in 2011 by the International Federation of Cervical Pathology and Colposcopy (IFCPC), with excision type 1 applied for completely visible, ectocervically situated TZ (i.e., TZ 1), excision type 2 for a TZ completely visible after extension (i.e., TZ 2), resecting a small part of endocervical epithelium, and excision type 3 if the TZ is not visible (i.e., TZ 3), including a significant amount of endocervical tissue [ 9 , 10 ]. While it is suggested that an excised cone length (distance between the ectocervical and the endocervical margin) of 10 mm should not be exceeded for a completely visible TZ, a considerably longer excision should be applied to a non-visible TZ [ 11 , 12 ]. Nevertheless, the advised length of cervical excision in relation to the TZ remains a recommendation and cannot be generalized for every patient, since the length of the cervix itself can vary considerably, as well as the location and extent of the neoplastic lesion.…”