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

Abstract

Objective:To determine the optimal cone size to achieve a reliable sensitivity and specificity for clear surgical margins after cold knife conization (CKC). Material and Methods:The medical reports of patients who had high-grade cervical intraepithelial lesions, carcinoma in situ, or stage 1A1 microinvasive carcinoma in their CKC specimens between June 2008 and January 2015 were reviewed retrospectively. Results:In total, 315 women fulfilled the inclusion criteria. The mean age of the patients was 40.7 years. The conization results were microinvasive carcinoma and high-grade squamous lesion (HSIL) for 8 and 307 patients, respectively. Ninety-nine patients had positive surgical margins. Eighty-one patients with positive cone margins underwent the repeat excisional procedure and 35 of them showed residual disease. In the univariate analyses, the patient age, menopausal status, and mean cone height parameters showed statistically significant differences between the patients with positive and negative margins. Also, residual disease was associated with the menopausal status and age of the patients. Conclusion:There is no optimal cone depth that is applicable for all patients. The most important predictors for positive margins are the menopausal status of the patient and that more than two quadrants are involved. However, the menopausal status and age of the patients were still predictors for residual disease. (J Turk Ger Gynecol Assoc 2016; 17: 159-2) Keywords: Cold knife conization, residual disease, surgical margin Received: 11 April, 2016 Accepted: 27 June, 2016 Optimal cone size to predict positive surgical margins after cold knife conization (CKC) and the risk factors for residual disease

Prevalence of group B Streptococcal colonization among pregnant women and neonates in a tertiary hospital in India

“…Previous studies investigating resection depth and margin status found conflicting results. Some studies found optimal depth for 10 mm resections ( 7 ), or confirmed 20 mm as the optimal depth ( 6 ), whereas the study of Öz et al ( 6 ) found no correlation between resection depth and margin status. The use of cold-knife excisions might have influenced the results of the studies of Öz et al ( 6 ) and Kliemann et al ( 7 ), which makes a comparison with the results of the present study difficult.…”

“…On the other hand, Noehr et al ( 5 ) described an increasing risk for preterm delivery depending on the depths of the resected cone. Due of this dilemma, there are no clear recommendations for depth of excisions of dysplastic lesions of the cervix uteri ( 6 , 7 , 8 ). Thus, the aim of this study was to find the optimal size of resected cone in order to achieve negative margin samples.…”

Twenty-Year Experience with Large Loop Excision of the Transformation Zone at Sestre Milosrdnice University Hospital Centre

“…Large loop excision of the transformation zone is a simple and rapid technique which is highly favored by gynecologists and patients in therapy of premalignant and early malignant cervical lesions because of its numerous advantages 1,2 . LLETZ offers individual approach to each patient with good performance and avoidance of excessive excision thanks to the availability of diverse shapes and size of loops [1][2][3][4] .…”

“…Proper understanding the disease along with right indication set for operative procedure and patient informed consent considering its limitations, complications and possible treatment failure are prerequisites for good outcome of the procedure. In comparison to cold knife cone biopsy, it has many advantages [1][2][3][4] .…”

Value of top‐hat procedure in management of squamous intraepithelial lesion

“…Extensive studies have been done to identify possible risk factors for residual lesions after LEEP. Apart from the well acknowledged edocervical margin involvement, other proposed factors include multi‐quadrant involvement, menopausal status, advanced age and type 3 transformation zone and post‐treatment HPV status . While HPV test can only be used for surveillance, the former ones can be assessed before LEEP and might assist the decision whether top‐hat is to be performed.…”