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        Identification of appropriate cone length to avoid positive cone margin in high grade cervical intraepithelial neoplasia

        Kouichiro Kawano,Naotake Tsuda,Shin Nishio,Koji Yonemoto,Kazuto Tasaki,Rurika Tasaki,Kimio Ushijima 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.5

        Objective: To identify key factors for predicting positive cone margin and appropriate conelength. Methods: We retrospectively reviewed the margin status of patients who received conizationwith high grade cervical intraepithelial neoplasia, along with other factors such as patientage, parity, preoperative cytology, size of disease, type of transformation zone, and conelength from patient records. Cut-off value of cone length was analyzed in women youngerthan 40 years old because we design conization with minimum length especially forwomen who wish for future pregnancy. Cut-off value of cone length was defined as lengthcorresponds to estimated probability of positive cone margin equal to 0.1 by logisticregression analysis with variables selected by stepwise methods. Results: Among 300 patients, 75 patients had positive cone margin. Multivariable analysisrevealed that squamous cell carcinoma at preoperative cytology (p=0.001), 2 or morequadrant disease (p=0.011), and shorter cone length (p<0.001) were risk factors for positivecone margin. Stepwise methods identified cone length and size of lesion as importantvariables. With this condition, cut-off value of cone length was estimated as 15 mm in singlequadrant disease and 20 mm in 2 or more quadrant disease, respectively. Conclusion: We identified the independent risk factors of positive cone margin and identifiedthe cut-off value of cone length to avoid positive cone margin in women younger than 40years old. Conization should be performed not only according to colposcopic findingsincluding type of transformation zone but size of disease and cone length.

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