Is “additional cut” effective for positive margin in cervical conization? It varies with doctors: a retrospective study

Objective: We aimed at discussing additional cuts, a common problem in cervical conization. Whether the doctor’s choice of additional cuts in conization surgery could reduce the occurrence of positive cone margin. Design: A retrospective study. Setting: First Affiliated Hospital of Dalian Medical University (Dalian, China). Population: 965 patients underwent cervical conization. Methods: Statistical analysis of patients’ pathological reports. Main outcome measures: The age, preoperative pathology, pathological results of conization, whether or not to make additional cuts, cone depth and cone volume were studied. Result: Of the 965 patients included, age, pathology result of conization, whether to make additional cuts, cone depth and cone volume, there were significant difference between positive and negative cone groups. Next, the Multivariable logistic regression analysis suggested that older age (OR,1.036; 95%CI, 1.017 to 1.054; p<0.001), the pathology result of conization was HSIL or cervical cancer (OR,13.203; 95%CI,6.024 to 28.936; p<0.001), additional cuts (OR, 2.480; 95%CI 1.608 to 3.826; p=0.01) and smaller cone depth (OR, 0.591; 95%CI, 0.362 to 0.965, p=0.036), these factors were the independent risk for the positive margin group. Conclusions: A certain proportion of additional cuts can be effectively excised the positive margin that cannot be cut in the initial conization. Moreover, choosing the appropriate cone size can maintain a low positive margin rate without additional cuts. Keywords: Additional cuts; Cone depth; Cone volume; Doctor’s habit; High-grade squamous intraepithelial lesion; Cervical cancer