Interpretability of Excisional Biopsies of the Cervix: Cone Biopsy and Loop Excision

Abstract

The loop electrosurgical excision procedure (LEEP) is more commonly used than cold knife conization (CKC) for diagnosis and treatment of cervical intraepithelial neoplasia (CIN). Several randomized trials have reported that LEEP is an easy-to-use, low-cost-effective technique that is more rapid and has favorable postoperative morbidity. However, earlier studies have demonstrated that margins with LEEP are often more frequently involved and more difficult to interpret than for CKC, and that positive margins are a strong predictor for residual disease. This retrospective study compared the results of CKC and LEEP to determine if these excision procedures had a deleterious effect on pathologic interpretation of CIN and treatment recommendations. Between 2003 and 2007, a review was conducted of the charts and perioperative records of patients who underwent a CKC and a LEEP. The patients selected had received either CKC or LEEP for primary treatment for CIN, suspected invasion, discordant cytology, or glandular abnormalities. Of the 157 eligible women available for analysis, 61 had CKC and 96 had LEEP. Interpretable surgical margins were found more frequently in CKC specimens compared to LEEP (95% vs. 85%), although the difference was not statistically significant (P = 0.1). Significant differences were observed between CKC and LEEP for number of specimens collected (1.1 vs. 1.9, respectively) (P = 0.000) and involvement of surgical margins (16% vs. 38%) (P = 0.005). These differences were maintained after logistic regression analysis to correct for predictor variables. These data show that LEEP is associated with an increased number of specimens that limit interpretability and an increase in the number of positive margins. The investigators conclude from these findings that CKC may be a better choice than LEEP in cases where margin status and interpretability of the surgical specimen are critical to a clinical treatment decision.