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.