title: Interpretability of excisional biopsies of the cervix: cone biopsy and loop excision.
abstract: OBJECTIVE
  To compare the results of cold knife conization (CKC) and loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia to determine if excisional method has effects on pathologic interpretation.
  
  
  METHODS
  Retrospective review of the perioperative medical records of patients who had a CKC and electrosurgical loop excision of cervix. Patients selected had either primary treatment for cervical intraepithelial neoplasia, suspected invasion, glandular abnormalities or discordant cytology.
  
  
  RESULTS
  Among the eligible patients, 61 had CKC and 96 had LEEP. Overall, CKC specimens had interpretable surgical margins more frequently than LEEP (95% vs 85%); however, it was not statistically significant (p=.1). Margins were less likely to be involved with neoplasia in CKC specimens (16% vs 38%; p=.005). Loop electrosurgical excision procedure specimens were less likely to yield a single intact specimen (1.1 vs 1.9; p=.000). Logistic regression showed a significant effect of specimen number (p=.04) on interpretability.
  
  
  CONCLUSIONS
  Current American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for diagnostic excisional procedure used for glandular lesions suggest that the procedure provides "an intact specimen with interpretable margins." Loop electrosurgical excision procedure in the current study was associated with an increased number of specimens that limited interpretability and an increased number of positive margins. Cold knife conization is preferred in cases where margin status is critical, such as glandular lesions and suspected microinvasion. If LEEP is performed, clinicians should attempt to obtain a single surgical specimen maximizing the pathologic interpretation and disease-free margins.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Lankenau Hospital, Main Line Health Care, Wynnewood, PA 19096, USA. genamir@gmail.com
authors.forename: Gennady G
authors.initials: GG
authors.lastname: Miroshnichenko
authors.forename: Mehdi
authors.initials: M
authors.lastname: Parva
authors.forename: David O
authors.initials: DO
authors.lastname: Holtz
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Klemens
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Dunton
mesh_terms: D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D019092:Conization; D004598:Electrosurgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery