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.