Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

Abstract

ObjectiveTo identify key factors for predicting positive cone margin and appropriate cone length.MethodsWe retrospectively reviewed the margin status of patients who received conization with high grade cervical intraepithelial neoplasia, along with other factors such as patient age, parity, preoperative cytology, size of disease, type of transformation zone, and cone length from patient records. Cut-off value of cone length was analyzed in women younger than 40 years old because we design conization with minimum length especially for women who wish for future pregnancy. Cut-off value of cone length was defined as length corresponds to estimated probability of positive cone margin equal to 0.1 by logistic regression analysis with variables selected by stepwise methods.ResultsAmong 300 patients, 75 patients had positive cone margin. Multivariable analysis revealed that squamous cell carcinoma at preoperative cytology (p=0.001), 2 or more quadrant disease (p=0.011), and shorter cone length (p<0.001) were risk factors for positive cone margin. Stepwise methods identified cone length and size of lesion as important variables. With this condition, cut-off value of cone length was estimated as 15 mm in single quadrant disease and 20 mm in 2 or more quadrant disease, respectively.ConclusionWe identified the independent risk factors of positive cone margin and identified the cut-off value of cone length to avoid positive cone margin in women younger than 40 years old. Conization should be performed not only according to colposcopic findings including type of transformation zone but size of disease and cone length.

Clinicopathological Factors that Predict Endocervical Margin Involvement of CIN2+ after Cervical Conization Procedure in the Tertiary Center, Rajavithi Hospital, Thailand

“…From our multivariate analysis, the risk of positive endocervical margin of CIN2+ increases in women age of ≥50 years old (2.84 times compared with age <50 years old) and positive glandular involvement of LEEP specimen (2.41 times compared with negative glandular involvement). It is established that the chance of complete cervical excision increased with increasing cone length [14]. For this reason, LEEP in the patient with age of ≥50 years old should be deeply cut.…”

Elektrocerrahi ile eksizyon sonrası cerrahi sınır pozitif yüksek dereceli servikal intraepitelyal lezyon olgularında lezyonun sebat etmesi ile ilişkili parametreler

“…Kawano ve ark. [4] HSIL nedeni ile konizasyon yapılan 300 olguyu cerrahi sınır pozitifliği ile ilgili risk faktörlerini araştırmak amacı ile incelediler. Bu çalışmada hastaların 75'inde cerrahi sınır pozitifliği mevcuttu.…”

“…Kawano ve ark. 'nın [4] cerrahi sınır pozitifliği açısından riskli bulduğu parametreleri (sitoloji, kon boyutu, multiple odak varlığı) re-eksizyon materyalinde rezidü lezyon varlığı açısından karşılaştırdığımızda çalışmamızda gruplar arasında anlamlı farklılık saptamadık.…”

“…Hastalığın persistansı ve/veya rekürrensi açısından; yaş, multiparite, Human Papillomavirus (HPV) persistansı, yüksek dereceli lezyonun büyüklüğü, eksizyon büyüklüğü ve cerrahi sınır pozitifliği olası risk faktörleri arasında sayılabilir [4,5]. Risk faktörlerinin değerlendirildiği iki kapsamlı metaanalizin sonuçları özellikle pozitif cerrahi sınır varlığının persistan veya rekürren hastalığın güçlü bir prediktörü olduğu yönündedir [6,7].…”

Introducing a novel model for simulating large loop excision of the transformation zone (LLETZ) using 3D printing technique

“…In case of a High-Grade Squamous Intraepithelial Lesion (HSIL), therapy can be indicated. It is the aim of the local therapy to remove dysplastic areas as well as the transformation zone of the cervix (R0-resection) [6][7][8][9]. This can be done by performing a so-called large loop excision of the transformation zone (LLETZ) [2,10].…”