title: The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity.
abstract: OBJECTIVE
  To analyse factors associated with endocervical cone margin involvement and suggest appropriate cone depth for the conization procedure.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Gynecological oncology center.
  
  
  METHODS
  One thousand two hundred and twenty women undergoing conization for cervical intraepithelial neoplasia (CIN) II or III or stage IA1 microinvasive cervical carcinoma.
  
  
  METHODS
  The following factors were analysed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic curve analyses were used to determine the best cut-off points to define appropriate cone depth.
  
  
  METHODS
  Cone depth to avoid endecervical margin involvement.
  
  
  RESULTS
  Ninety-one women had endocervical margin involvement (7.5%). This was positively associated with disease severity and age and inversely related to cone depth. In women under 50 years of age, the cut-off value was achieved at 1.8 cm cone depth, with high sensitivity and relatively low specificity [area under the curve (AUC) 0.64, sensitivity 0.86, specificity 0.27, p= 0.005]. For a subset of CIN II patients aged ≤50 years, the cut-off value was 1.2 cm (AUC 0.75, sensitivity 0.90, specificity 0.47, p= 0.008). In women <40 years of age, the cut-off value was 1.8 cm (AUC 0.60, sensitivity 0.88, specificity 0.25, p= 0.036). In a subset of CIN II, the cut-off value was 0.9 cm (AUC 0.87, sensitivity 0.83, specificity 0.69, p= 0.002).
  
  
  CONCLUSIONS
  Age, disease severity and cone depth are predictive factors for endocervical margin involvement. In women of reproductive age, the appropriate cone depth to avoid endocervical margin involvement can be changed depending on age and disease severity.
authors.affiliation: Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea.
authors.forename: Hyo Sook
authors.initials: HS
authors.lastname: Bae
authors.forename: Ye Won
authors.initials: YW
authors.lastname: Chung
authors.forename: Tak
authors.initials: T
authors.lastname: Kim
authors.forename: Kyu Wan
authors.initials: KW
authors.lastname: Lee
authors.forename: Jae Yun
authors.initials: JY
authors.lastname: Song
mesh_terms: D000328:Adult; D000367:Age Factors; D019540:Area Under Curve; D002584:Cervix Uteri / Q000473:pathology*; D019092:Conization; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D002578:Uterine Cervical Dysplasia / Q000473:pathology