title: Appropriate cone dimensions to achieve negative excision margins after large loop excision of transformation zone in the uterine cervix for cervical intraepithelial neoplasia.
abstract: OBJECTIVE
  To determine appropriate cone dimensions for predicting margin status after large loop excision of transformation zone (LLETZ) treatment.
  
  
  METHODS
  An observational study performed at the Colposcopy Unit of a university hospital setting involving patients who underwent LLETZ conisation within a 1-year period. Data concerning the characteristics, cone dimensions, lesion grade and excision margins of the patients were recorded.
  
  
  RESULTS
  The median age of the women (n = 61) was 38 years (18-53). LLETZ cone specimens had 36.1% of cervical intraepithelial neoplasia (CIN)2/3 lesion and 13.1% positive margins. Mean cone depth and volume were 10.9 mm and 2.3 cm(3), respectively. Multiple logistic regression for main predictors and after adjustment for age, parity and CIN severity showed that cone volume and length, cone base surface and proportion of excised volume had a significant effect on margin positivity. ROC analysis showed that optimal cut-off for cone volume was 2.1 cm(3) (87.5% sensitivity - 54.7% specificity) or 8.6% of initial cervical volume (75% sensitivity - 75.5% specificity), and for cone length it was 10 mm (100% sensitivity - 52.8% specificity). Optimal cut-off for cone base surface as percentage of ectocervical surface was 32.7% (75% sensitivity - 69.8% specificity).
  
  
  CONCLUSIONS
  These findings should be taken into consideration when planning the outer boundaries of excision and cervical tissue to be removed so as to achieve oncologically safe limits.
authors.affiliation: First Department of Obstetrics and Gynaecology, University of Athens, Athens, Greece. DiPapoutsis @ yahoo.com
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papoutsis
authors.forename: Alexandros
authors.initials: A
authors.lastname: Rodolakis
authors.forename: Spiridon
authors.initials: S
authors.lastname: Mesogitis
authors.forename: Maria
authors.initials: M
authors.lastname: Sotiropoulou
authors.forename: Aris
authors.initials: A
authors.lastname: Antsaklis
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology* / Q000601:surgery; D003127:Colposcopy / Q000379:methods*; D019092:Conization / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*