title: Preoperative predictors of positive margins after loop electrosurgical excisional procedure-Cone.
abstract: 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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Tennessee at Memphis, 854 Jefferson Ave., Room E-102, Memphis, TN 38163, USA. ttillmanns@westclinic.com
authors.forename: Todd D
authors.initials: TD
authors.lastname: Tillmanns
authors.forename: Camille A
authors.initials: CA
authors.lastname: Falkner
authors.forename: David B
authors.initials: DB
authors.lastname: Engle
authors.forename: Jim Y
authors.initials: JY
authors.lastname: Wan
authors.forename: Robert S
authors.initials: RS
authors.lastname: Mannel
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.forename: Gary A
authors.initials: GA
authors.lastname: Johnson
authors.forename: D Scott
authors.initials: DS
authors.lastname: McMeekin
authors.forename: Rosemarry
authors.initials: R
authors.lastname: Zuna
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gold
mesh_terms: 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*