Enes Serhat COŞKUN, Fatma Ketenci GENCER, Havva Betül BACAK, Alperen AKSAN, Süleyman SALMAN
Journal of Academic Research in Medicine - 2026;16(2):56-62
Objective: Positive surgical margins (PSM) after excisional treatment for cervical intraepithelial lesions affect surveillance and repeat treatment. Cone depth is modifiable, but deeper excision may increase obstetric risk. We assessed PSM prevalence, associated factors, and colposcopy-histology agreement. Methods: We conducted a single-center retrospective cohort study of patients who underwent loop electrosurgical excision procedure (LEEP) or cervical conization between 7 January 2015 and 26 September 2025. PSM was defined as margin involvement at any surgical margin. Factors associated with PSM were evaluated using multivariable bias-reduced (Firth) logistic regression including cone depth (cm, continuous), high-grade squamous intraepithelial lesion (HSIL)-or-higher grade histology on the excision specimen (yes/no), and procedure type (LEEP vs. conization), using a complete-case approach. Results: Among 246 patients, 92 (37.4%) underwent LEEP and 154 (62.6%) conization. Median cone depth was 1.6 cm (interquartile range 1.0-2.5) and was greater with conization than LEEP (2.0 vs. 1.5 cm; p<0.001). PSM occurred in 20/241 (8.3%) and did not differ between LEEP and conization (6.6% vs. 9.3%). Reconization was performed in 57/243 (23.5%) and was more frequent after conization (30.5% vs. 12.0%). Recurrence occurred in 16/246 (6.5%). In the Firth model (complete cases n=215; 18 PSM events), greater cone depth was associated with lower odds of PSM (adjusted odds ratio 0.46 per 1-cm increase; 95% confidence interval 0.24-0.88; p=0.018), whereas HSIL-or-higher histology and procedure type were not statistically significant. Colposcopy-histology agreement was low (Cohen's kappa=0.168). Follow-up human papillomavirus (HPV) results were available for a small subset and are descriptive. Conclusion: Greater cone depth was associated with reduced odds of PSM. Given limited event numbers and non-standardized follow-up, non-significant associations and HPV outcomes should be interpreted cautiously. Tailoring excision depth to lesion location may reduce margin positivity while balancing obstetric risks.
