title: How to optimize excisional procedures for the treatment of CIN? The role of colposcopy.
abstract: OBJECTIVE
  To evaluate the value of colposcopy during excisional treatment of cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  Data from 469 women who underwent excisional treatment for CIN in three different hospitals between January 2005 and December 2009 were reviewed. Margins status and surgical specimen dimensions were analyzed according to the use of colposcopy during procedure.
  
  
  RESULTS
  The rate of negative margins was not significantly different between women who had excision performed without colposcopic examination, with colposcopy immediately before excision and with direct colposcopic vision (DCV): 74 (62.2%), 186 (72.9%) and 25 (67.6%), respectively (p = 0.107). DCV allowed for significantly higher probability to achieve both negative margins and depth of specimen of less than 10 mm: 22 (18.5%) versus 70 (27.5%) versus 14 (37.8%), respectively (p = 0.039). In multivariate analysis, compared to women who had excision without any use of colposcopy, DCV allowed for significant and independent reduction in both depth (ß: -2.46; 95%CI: -4.45 to -0.47; p = 0.015) and diameter (ß: -4.80; 95%CI: -7.14 to -2.47; p < 0.001) of the surgical specimen. Compared to the use of colposcopy immediately before excision, DCV allowed for a significant and independent reduction in diameter of the surgical specimen (ß: -6.57; 95%CI: -8.78 to -4.35; p < 0.001) without significantly changing its depth (ß: -1.10; 95%CI: -3.01 to -0.80; p = 0.255).
  
  
  CONCLUSIONS
  Use of colposcopy, and particularly of DCV during excisional procedures for CIN, allows for smaller surgical specimen without jeopardizing the margins status.
authors.affiliation: Department of Obstetrics and Gynaecology, Assistance Publique des Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrelly, 13015 Marseille, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Grisot
authors.forename: Julien
authors.initials: J
authors.lastname: Mancini
authors.forename: Sophie
authors.initials: S
authors.lastname: Giusiano
authors.forename: Gilles
authors.initials: G
authors.lastname: Houvenaeghel
authors.forename: Aubert
authors.initials: A
authors.lastname: Agostini
authors.forename: Claude
authors.initials: C
authors.lastname: d'Ercole
authors.forename: Léon
authors.initials: L
authors.lastname: Boubli
authors.forename: Walter
authors.initials: W
authors.lastname: Prendiville
authors.forename: Xavier
authors.initials: X
authors.lastname: Carcopino
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*