Conization of the uterine cervix: does the level of gynecologist's training predict margin status?

The management of cervical intraepithelial neoplasia is becoming more individualized. The European Federation of Colposcopy has developed guidelines for quality assurance and also certifies specialists. The status of the resection margins of conization specimens is prognostically important and is a quality feature. We examined the rate of positive margins in conization specimens according to the training level of the gynecologic surgeon. We reviewed the hospital charts of 411 consecutive patients who underwent conization for cervical intraepithelial neoplasia or adenocarcinoma in situ between November 2006 and December 2009. Preoperative colposcopy was performed to localize and characterize the transformation zone and the lesion in all cases. Ninety-seven conizations were performed by residents, 138 by staff members, and 124 by 1 certified specialist for colposcopy. A total of 334 cold-knife conizations and 25 loop electrosurgical excision procedures were carried out. The rates of positive histologic margins in conization specimens were 16%, 22%, and 5% for residents, staff members, and the certified specialist, respectively (P<0.001). Expertise of the gynecologic surgeon in performing conization procedures appears to influence the rate of involved margins after conization. These data support quality-assured preoperative colposcopy and European Federation of Colposcopy quality assurance criteria. Specialization of gynecologic staff members in the field of colposcopy is warranted.