Preoperative predictors of positive margins after loop electrosurgical excisional procedure–Cone

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.