Preoperative predictors of positive margins after loop electrosurgical excisional procedure-Cone.
OBJECTIVE
A LEEP-Cone may not be necessary for all patients with traditional cone indications. This study defines populations where a single pass technique with the LEEP is appropriate.


METHODS
We retrospectively reviewed patients undergoing LEEP-Cone procedures performed at the University of Oklahoma Health Science Center from February of 1994 to July of 2002. Patients include those for LEEP-Cone with traditional excisional indications and those who underwent LEEP-Cone at the operating physician's discretion. Statistical analysis was used to compare preoperative factors with the resultant pathologic results.


RESULTS
A total of 248 women underwent LEEP-Cone. 50.0% (33/66) of the patients with positive margins on the first pass had dysplasia or worse (CIN I-III or CA) in the second pass (top hat), compared to 6.6% (12/182) of the patients with a negative first pass (P < 0.0001). Univariate analysis found CIN III on histology and parity to be predictive of dysplasia in the top hat and two-step discrepancy to predict absence of dysplasia. On multivariate analysis, two-step discrepancy and parity remained predictive. Age >35 was the greatest percentile predictor of dysplasia in the top hat, and 91.5% of women <21 had normal top hat pathology.


CONCLUSIONS
The retrospective data reported regarding LEEP-Cones reveal increased parity to predict dysplasia in the top hat and two-step discrepancy as a poor predictor of dysplasia in the top hat. Women under 21 years of age should have a single pass LEEP technique. The "top hat" is more appropriate as parity and age increase.
Tillmanns
Todd D
TD
Department of Obstetrics and Gynecology, University of Tennessee at Memphis, 854 Jefferson Ave., Room E-102, Memphis, TN 38163, USA. ttillmanns@westclinic.com
Falkner
Camille A
CA
Engle
David B
DB
Wan
Jim Y
JY
Mannel
Robert S
RS
Walker
Joan L
JL
Johnson
Gary A
GA
McMeekin
D Scott
DS
Zuna
Rosemarry
R
Gold
Michael A
MA
D000328:Adult; D019092:Conization / Q000379:methods*; D004598:Electrosurgery; D005260:Female; D006801:Humans; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*