O bjective: To compare cone specimen size between loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC), and evaluate the association between specimen size and margin status. Methods/materials: A retrospective review was performed of women with adenocarcinoma in situ (AIS) who underwent CKC or LEEP between 1998 and 2013. Specimen size, including length (distance from the external cervical os to the endocervical margin) and volume were compared between LEEP and CKC, and correlated with margin status. Results: Eighty-five patients underwent a total of 136 procedures, including 91 CKCs (67%) and 45 LEEPs (33%), with 27 removed as a single specimen (one-piece LEEP) and 18 as two specimens with an ectocervical specimen and a deeper endocervical tophat specimen (two-piece LEEP). The two-piece LEEP specimen median length was significantly longer (2.1 cm) versus CKC (1.4 cm, p<0.01) and one-piece LEEP (0.6 cm, p<0.01). Median specimen volume was greater for two-piece LEEP (7.4 cm 3 ) versus CKC (3.4 cm 3 , p<0.01) and one-piece LEEP (1.6 cm 3 , p<0.01). A higher rate of positive margins was noted when comparing all LEEP (67.6%) with CKC specimens (34.2%), p<0.01. However, when the LEEP specimens were analysed separately, one-piece LEEPs had a higher rate of positive margins (81.0%) versus CKC (34.2%) (p<0.01), but there were no significant differences between two-piece LEEP (50.0%) and CKC (34.2%), p=0.26. Conclusion: Our results suggest that a two-piece LEEP produces a larger specimen size with similar rates of positive margins compared with CKC. Given the decreased cost and morbidity compared with CKC, a two-piece LEEP should be considered in the management of women with AIS.
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Compliance with Ethics:This study involves a retrospective review and did not involve any studies with human or animal subjects performed by any of the authors. Institutional Review Board approval was obtained with a waiver of informed consent.Authorship: All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval to the version to be published.Open Access: This article is published under the Creative Commons Attribution Noncommercial License, which permits any non-commercial use, distribution, adaptation and reproduction provided the original author(s) and source are given appropriate credit. Cervical adenocarcinoma in situ (AIS) is recognised as a premalignant glandular condition and is a precursor to invasive cervical adenocarcinoma.1 It usually affects women of childbearing age in which a more conservative approach is preferred.1-3 The incidence of both AIS and adenocarcinoma of the cervix has been increasing, especially among young women.4,5 Cervical conisation, or cone biopsy, can be performed using a scalpel (cold knife cone [CKC]), laser, or electrosurgery (loop electrosurgical excision procedure [LEEP]). For patients with squamous dysplasia (cervical...