Predicting risk factors for suboptimal excision in women undergoing cold-knife cone biopsy

Objective. Our goal was to identify risk factors for suboptimal excision in relation to a positive endocervical curettage (ECC) after conization or positive specimen margin. Materials and Methods. A retrospective review of referral cytology and colposcopy results for 280 women undergoing conization at two urban teaching centers was performed. Mann-Whitney or Pearson's chi-square test was used to determine significant associations between preoperative variables and positive cone margin, positive intraoperative ECC, and either positive margin or positive intraoperative ECC. Results. Cytology grade, gravidity, parity, and race were not significantly correlated with any outcome variable. Using logistical regression analyses, correlates of positive ECC after conization included increasing age (p = .01), positive colposcopic biopsy (p = .01), colposcopic inadequacy (p = .01), and positive preoperative ECC (p = .03). Positive preoperative ECC was the only significant risk factor for positive cone margin (p = .02) or the combination of either positive intraoperative ECC or positive cone margin (p = .0001). Conclusion. A positive preoperative ECC is the best predictor of suboptimal excision at conization and should be performed unless contraindicated.