1 Introduction:
Cervical cancer is one of the most common cancers among women, meanwhile
the mortality of cervical cancer is high, in 2020 there were estimated
604,000 newly cases and 342,000 cases of death worldwide. Research
suggests that squamous intraepithelial lesion (SIL) caused by persistent
infection of Human Papillomavirus (HPV) is closely related to the
occurrence of cervical cancer, so effective screening measures for SIL
can be a great way to prevent.1,2 For women with
histologically confirmed high-grade squamous intraepithelial lesion
(HSIL), we have used cold knife conization (CKC), loop electrosurgical
excision procedure (LEEP; including large loop excision of the
transformation zone or cone biopsy with loop excision) and laser
conization (LC) to do the conization with a diagnostic purpose, also as
a principal treatment approach .3
In clinical work, it is common to have positive margins at the time of
making cervical conizaiton, a meta-analysis showed that about 25% of
cases occur incomplete excision, and some researchers considered the
proportion of complete excision of lesions to be a quality criterion for
clinical practice.4 Several variables such as age more
than 50 years, high parity, menopausal status have been reported to be
associated with positive margin.5,6 Furthermore,
positive margin is one of the main causes of HSIL recurrence, for women
with positive margin, there is a higher risk of residual or recurrent
HSIL or worsening than women with clean margin, patients with positive
cone margin had a nearly 2.7-fold recurrence rate than patients with
negative cone margin.5,7,8 Consequently, when doing
conization surgery, some doctors may worry about positive margin shown
on the pathology reports because their cut range was not enough, and
they choose to make additional cuts when doing conization. However,
whether the additional cuts can effectively avoid the appearance of
positive margin is still unclear. Only a few articles mentioned the
addition cuts, making it when necessary and additional cut does not
appear to have a good preventive effect on cervical
cancer.9,10 Also, to the author’s knowledge, there is
little information in the literature about the association between the
positive margin and the choice to make additional cuts.
In this study, we retrospectively analyzed pathology report data from
patients, who underwent cervical conization, to find out whether making
additional cuts could reduce the rate of positive margin in cervical
conization. This study aims to provide a suitable choice for doctors to
make additional cuts in cervical conization.