Is “additional cut” effective for positive margin in cervical
conization? It varies with doctors: a retrospective study
Abstract
Objective: We aimed at discussing additional cuts, a common problem in
cervical conization. Whether the doctor’s choice of additional cuts in
conization surgery could reduce the occurrence of positive cone margin.
Design: A retrospective study. Setting: First Affiliated Hospital of
Dalian Medical University (Dalian, China). Population: 965 patients
underwent cervical conization. Methods: Statistical analysis of
patients’ pathological reports. Main outcome measures: The age,
preoperative pathology, pathological results of conization, whether or
not to make additional cuts, cone depth and cone volume were studied.
Result: Of the 965 patients included, age, pathology result of
conization, whether to make additional cuts, cone depth and cone volume,
there were significant difference between positive and negative cone
groups. Next, the Multivariable logistic regression analysis suggested
that older age (OR,1.036; 95%CI, 1.017 to 1.054; p<0.001),
the pathology result of conization was HSIL or cervical cancer
(OR,13.203; 95%CI,6.024 to 28.936; p<0.001), additional cuts
(OR, 2.480; 95%CI 1.608 to 3.826; p=0.01) and smaller cone depth (OR,
0.591; 95%CI, 0.362 to 0.965, p=0.036), these factors were the
independent risk for the positive margin group. Conclusions: A certain
proportion of additional cuts can be effectively excised the positive
margin that cannot be cut in the initial conization. Moreover, choosing
the appropriate cone size can maintain a low positive margin rate
without additional cuts. Keywords: Additional cuts; Cone depth; Cone
volume; Doctor’s habit; High-grade squamous intraepithelial lesion;
Cervical cancer