An Abnormal Precone Endocervical Curettage Result Is an Independent Risk Factor for Positive Margins in Conization Specimens

Abstract

This study aimed to identify risk factors associated with the presence of positive surgical margins in cervical conization specimens. Methods: This study is a retrospective analysis of data from women who had undergone conization for cervical intraepithelial neoplasia (CIN) from 2012 to 2018 at Fujian Maternity and Child Health Hospital. Factors extracted from the database included age, gravidity, parity, menopausal status, precone Thinprep cytology test, human papillomavirus (HPV) test, precone biopsy, precone endocervical curettage (ECC) result, conization method, operating surgeon, cone dimension, and pathology of the conization specimen, including grade of CIN, margin status and glandular involvement. Univariate and multivariate analyses were performed to identify risk factors associated with positive margins. Results: Data from 495 women were analysed. The proportion of positive margins was 24.85% overall, which varied according to the conization method (27.22% for loop electrosurgical excision procedure vs. 18.52% for cold-knife conization, p = 0.047) and was increased as the severity of the treated lesion increased (10.07% for CIN2 vs. 30.62% for CIN3, p < 0.001). HPV-16 genotype infection, abnormal precone ECC result, higher grade of biopsy, larger cone length and volume, and glandular involvement were significantly associated with positive margins on univariable analysis. After logistic regression analysis, only an abnormal precone ECC result (odds ratio 1.952; 95% confidence interval 1.037-3.676; p = 0.038) remained significant. Conclusions: In the present study, an abnormal precone ECC result was identified as an independent risk factor for positive margins in cervical conization specimens. More aggressive treatment may be considered in patients with abnormal precone ECC results in clinical practice.

Additional role of ECC in the detection and treatment of cervical HSIL

“…The proportion of residual lesions after LEEP was 43.48%. Therefore, for these patients, we should adopt more active treatment ( 21 ), and the conization depth should be properly increased to prevent positive postoperative margins. ECC was performed immediately after conical resection to remind the possibility of residual lesions in the cervical canal.…”

“…It is worth noting that when the ECC result was higher than the pathological result of targeted biopsy, the positive rate of LEEP resection margin or ECC after surgery was 32.08%, which may be related to the type of lesion in the cervical canal. Therefore, during the operation, doctors should appropriately increase the depth of conization and perform ECC immediately after cervical coning to avoid a missed diagnosis in the residual cervical canal ( 21 ).…”

Development of a Nomogram Predicting the Risk of Persistence/Recurrence of Cervical Dysplasia

“…However, positive ectocervical margin also significantly impacted the risk of developing persistent/recurrent disease. Moreover, we have to take into consideration that the severity of the dysplasia might correlate with the size of the cervical lesions [30][31][32][33].…”

Risk factors for residual lesions after total hysterectomy in patients with high-grade cervical intraepithelial neoplasia

“…The percentage of positive LEEP residue was as high as 12-26% [9,10,13,14]. Some studies have confirmed that the risk factors associated with CIN 2/3 residue include residual margin, lesion size, lesion severity and location, depth and method of excision, patient age and menopausal status, and the presence of HR-HPV after excision [14][15][16][17][18][19][20].…”