Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article.
Main Research Article
The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity
Article first published online: 5 DEC 2012
© 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology
Acta Obstetricia et Gynecologica Scandinavica
Volume 92, Issue 2, pages 185–192, February 2013
How to Cite
BAE, H. S., CHUNG, Y. W., KIM, T., LEE, K. W. and SONG, J. Y. (2013), The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity. Acta Obstetricia et Gynecologica Scandinavica, 92: 185–192. doi: 10.1111/aogs.12025
Please cite this article as: Bae HS, Chung YW, Kim T, Lee KW, Song JY. The appropriate cone depth to avoid endocervical margin involvement is dependent on age and disease severity. Acta Obstet Gynecol Scand 2012;91: DOI: 10.1111/aogs.12025.
- Issue published online: 23 JAN 2013
- Article first published online: 5 DEC 2012
- Accepted manuscript online: 4 OCT 2012 05:27AM EST
- Received: 21 May 2012 Accepted: 25 September 2012
- Cervical cone margin;
- cervical intraepithelial neoplasia;
- cervix uteri;
- cone depth;
- uterine cervical neoplasm
Objective. To analyse factors associated with endocervical cone margin involvement and suggest appropriate cone depth for the conization procedure. Design. Retrospective cohort study. Setting. Gynecological oncology center. Population. One thousand two hundred and twenty women undergoing conization for cervical intraepithelial neoplasia (CIN) II or III or stage IA1 microinvasive cervical carcinoma. Methods. The following factors were analysed: age, parity, gravida, conization type, margin status, disease severity and specimen depth. Receiver operating characteristic curve analyses were used to determine the best cut-off points to define appropriate cone depth. Main outcome measures. Cone depth to avoid endecervical margin involvement. Results. Ninety-one women had endocervical margin involvement (7.5%). This was positively associated with disease severity and age and inversely related to cone depth. In women under 50 years of age, the cut-off value was achieved at 1.8 cm cone depth, with high sensitivity and relatively low specificity [area under the curve (AUC) 0.64, sensitivity 0.86, specificity 0.27, p= 0.005]. For a subset of CIN II patients aged ≤50 years, the cut-off value was 1.2 cm (AUC 0.75, sensitivity 0.90, specificity 0.47, p= 0.008). In women <40 years of age, the cut-off value was 1.8 cm (AUC 0.60, sensitivity 0.88, specificity 0.25, p= 0.036). In a subset of CIN II, the cut-off value was 0.9 cm (AUC 0.87, sensitivity 0.83, specificity 0.69, p= 0.002). Conclusions. Age, disease severity and cone depth are predictive factors for endocervical margin involvement. In women of reproductive age, the appropriate cone depth to avoid endocervical margin involvement can be changed depending on age and disease severity.