ArticleBMC women's health2026
Cold-knife conization versus loop electrosurgical excision for cervical adenocarcinoma in situ: a retrospective cohort study.
Article in BMC women's health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe purpose of this study was to compare the efficacy of cold-knife conization (CKC) and loop electrosurgical excision procedure (LEEP) in treating cervical adenocarcinoma in situ (AIS) and identify relevant risk factors within a recent cohort from a tertiary hospital in China.
methodsWe conducted a retrospective chart review of patients who underwent a conization procedure with a preoperative or postoperative diagnosis of AIS of the cervix from January 2021 to July 2024. Clinicopathological data and follow-up results were collected, with recurrence-free survival (RFS) as the primary endpoint.
resultsAmong the 251 patients included, 161 (64.14%) underwent LEEP and 90 (35.86%) underwent CKC as primary treatment. Overall, 29.9% (75/251) underwent eventual hysterectomy. Median follow-up was 36 months. The positive margin rate was lower in the CKC group than in the LEEP group (16.7% vs. 31.7%, P < 0.001). Multivariate analysis showed that LEEP (aOR 2.28, 95% CI 1.13-4.58, P = 0.021), TZ type 2 or 3 (aOR 2.00, 95% CI 1.12-3.58, P = 0.019), and AIS with concurrent HSIL (aOR 2.07, 95% CI 1.13-3.78, P = 0.018) were independently associated with positive margins. Greater cone depth was associated with lower risk (per 1 mm increase: aOR 0.73, 95% CI 0.55-0.97, P = 0.031) when conization type was excluded due to collinearity. Among patients who underwent hysterectomy, positive conization margin was the only predictor of residual disease (aOR 9.12, 95% CI 1.07-77.8, P = 0.043). Kaplan-Meier analysis showed a significant difference in RFS among the three groups (P = 0.018), but pairwise comparison did not reveal a significant difference between the LEEP and CKC groups (P = 0.109).
conclusionsIn this retrospective cohort, CKC achieved lower positive margin rates than LEEP for AIS. However, short-term RFS did not differ significantly between the two techniques, suggesting that margin status alone may not fully predict oncologic outcomes. Positive margin was a predictor of residual disease at hysterectomy, but this finding requires validation. For fertility-seeking patients, CKC is preferred to optimize margins, though LEEP may be acceptable when CKC is not feasible.
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