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

Todd Tillmanns, Camille A. Falkner, David B. Engle, Jim Wan, Robert S. Mannel, Joan L. Walker, Gary A. Johnson, D. Scott McMeekin, Rosemarry Zuna, Michael A. Gold

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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.

Original languageEnglish (US)
Pages (from-to)379-384
Number of pages6
JournalGynecologic oncology
Volume100
Issue number2
DOIs
StatePublished - Feb 1 2006

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Pathology
Physicians
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All Science Journal Classification (ASJC) codes

  • Oncology
  • Obstetrics and Gynecology

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Preoperative predictors of positive margins after loop electrosurgical excisional procedure-Cone. / Tillmanns, Todd; Falkner, Camille A.; Engle, David B.; Wan, Jim; Mannel, Robert S.; Walker, Joan L.; Johnson, Gary A.; McMeekin, D. Scott; Zuna, Rosemarry; Gold, Michael A.

In: Gynecologic oncology, Vol. 100, No. 2, 01.02.2006, p. 379-384.

Research output: Contribution to journalArticle

Tillmanns, T, Falkner, CA, Engle, DB, Wan, J, Mannel, RS, Walker, JL, Johnson, GA, McMeekin, DS, Zuna, R & Gold, MA 2006, 'Preoperative predictors of positive margins after loop electrosurgical excisional procedure-Cone', Gynecologic oncology, vol. 100, no. 2, pp. 379-384. https://doi.org/10.1016/j.ygyno.2005.09.015
Tillmanns, Todd ; Falkner, Camille A. ; Engle, David B. ; Wan, Jim ; Mannel, Robert S. ; Walker, Joan L. ; Johnson, Gary A. ; McMeekin, D. Scott ; Zuna, Rosemarry ; Gold, Michael A. / Preoperative predictors of positive margins after loop electrosurgical excisional procedure-Cone. In: Gynecologic oncology. 2006 ; Vol. 100, No. 2. pp. 379-384.
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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.",
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AU - Tillmanns, Todd

AU - Falkner, Camille A.

AU - Engle, David B.

AU - Wan, Jim

AU - Mannel, Robert S.

AU - Walker, Joan L.

AU - Johnson, Gary A.

AU - McMeekin, D. Scott

AU - Zuna, Rosemarry

AU - Gold, Michael A.

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N2 - 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.

AB - 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.

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