2 Methods:
We retrospectively reviewed the records of 1002 patients who underwent cervical conization (including CKC and LEEP) at the First Affiliated Hospital of Dalian Medical University (Dalian, China) from January 2018 to October 2019, including patients with HSIL, cervical squamous carcinoma, adenocarcinoma in situ (AIS), and few patients with low-grade squamous intraepithelial lesion (LSIL), on the preoperative diagnosis reports. Of the 1002 patients, 965 patients got clear margin results on their pathology reports and data information was complete, excluding 17 patients with the cut margins cannot be assessed and 20 patients with missing data (Fig. 1) . According to the pathological results of the conization, the patients were divided into two groups, positive cone margin group (n=174) and negative cone margin group (n=791). This study was approved by Ethics Committee of the First Hospital of Dalian Medical University.
In previous studies of conization, positive margin were defined as there are lesions (LSIL, HSIL, or cervical cancer) at or near (\(\leq\)1mm) the cut surface,11,12 but in this study, the definition of positive margin used for this analysis included the distance between the lesion and the cut surface was \(\leq\)1mm, and (or) there are lesions at the site of additional cut. The expansion of the definition of positive margin allows unclean margin cases, like margin is negative but have lesions at the additional cut site, were included in the study. For patients who underwent additional cuts, we think that the additional cut is effective if there is a lesion (LSIL, HSIL, or cervical cancer) at the site of additional cut. In this study, we defined doctors, who have the habit of making additional cut, as additional cut rate greater than 20% and surgical involvement more than five.
IBM SPSS statistics version 25 was used for statistical analysis. Chi-square test (\(\chi^{2}\) test) and Mann-Whitney U test were used to compare clinicopathological variables (age, preoperative pathology results, pathology results of conization tissue, whether to make additional cuts, the depth and volume of cone) between positive margin group and negative margin group. Multivariable logistic regression analyses were used to test the value of clinical parameters in predicting positive margin. A p values of\(<\)0.05 was considered statistically significant.