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Preoperative predictors of positive margins after loop electrosurgical excisional procedure-Cone.

Abstract：

OBJECTIVE:A LEEP-Cone may not be necessary for all patients with traditional cone indications. This study defines populations where a single pass technique with the LEEP is appropriate. METHODS:We retrospectively reviewed patients undergoing LEEP-Cone procedures performed at the University of Oklahoma Health Science Center from February of 1994 to July of 2002. Patients include those for LEEP-Cone with traditional excisional indications and those who underwent LEEP-Cone at the operating physician's discretion. Statistical analysis was used to compare preoperative factors with the resultant pathologic results. RESULTS:A total of 248 women underwent LEEP-Cone. 50.0% (33/66) of the patients with positive margins on the first pass had dysplasia or worse (CIN I-III or CA) in the second pass (top hat), compared to 6.6% (12/182) of the patients with a negative first pass (P < 0.0001). Univariate analysis found CIN III on histology and parity to be predictive of dysplasia in the top hat and two-step discrepancy to predict absence of dysplasia. On multivariate analysis, two-step discrepancy and parity remained predictive. Age >35 was the greatest percentile predictor of dysplasia in the top hat, and 91.5% of women <21 had normal top hat pathology. CONCLUSION:The retrospective data reported regarding LEEP-Cones reveal increased parity to predict dysplasia in the top hat and two-step discrepancy as a poor predictor of dysplasia in the top hat. Women under 21 years of age should have a single pass LEEP technique. The "top hat" is more appropriate as parity and age increase.

journal_name

Gynecol Oncol

journal_title

Gynecologic oncology

authors

Tillmanns TD,Falkner CA,Engle DB,Wan JY,Mannel RS,Walker JL,Johnson GA,McMeekin DS,Zuna R,Gold MA

doi

10.1016/j.ygyno.2005.09.015

subject

Has Abstract

pub_date

2006-02-01 00:00:00

pages

379-84

issue

2

eissn

0090-8258

issn

1095-6859

pii

S0090-8258(05)00796-1

journal_volume

100

pub_type

杂志文章

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