Minimal cold knife conization height for high-grade cervical squamous intraepithelial lesion treatment.

OBJECTIVES: To assess the relationship between cold-knife conization specimen height, cervical intraepithelial neoplasia (CIN II/III) size and endocervical margin involvement by CIN II/II.

STUDY DESIGN: A cross-sectional study was performed. Cold knife cone specimens with a diagnosis of CIN II/III were selected. Epidemiological data and pathology reports were obtained through a chart review. All samples from each cone specimen showing CIN II/III and the squamocolumnar junction were selected. Cone height (mean ± standard deviation), intraepithelial lesion size, and size of endocervical surgical margins were measured.

RESULTS: Four hundred and forty-seven samples were analyzed from 97 cone specimens. Section size ranged from 3.4 to 29.7 mm, tumor size from 0.3 to 17.5mm, and tumor distance from the endocervical margin, from 0.0 to 22.0mm. Age and parity were similar in the positive vs. negative margin groups (37.6 ± 10.0 years vs. 37.7 ± 11.9 years respectively, p=0.952, and 2.2 ± 1.7 births vs. 2.6 ± 1.9 births respectively, p=0.804), whereas cone height (22.4 ± 6.9 mm vs. 17.1 ± 5.6mm, p=0.013) and tumor size (6.12 ± 3.25 mm vs. 10.6 ± 4.45 mm, p<0.001) were significantly different in negative vs. positive margin groups respectively.

CONCLUSIONS: Use of cone height to identify the likelihood of negative margins enables better estimation of the risk-benefit ratio of greater risks of bleeding, stenosis, and obstetric complications (cervical incompetence) versus greater risks of residual and recurrent disease.