Determinants of Cone Volume During Large Loop Excision of the Transformation Zone (LLETZ) and Their Association with Specimen Fragmentation and Excisional Margin—A Cross-Sectional Study

Objective: Given the variability in conization cone volume, specimen fragmentation, and histopathological excisional margin status, even in optimally performed procedures, the study aimed to assess the factors affecting these characteristics. Methods: This cross-sectional study based on retrospectively collected data, included 179 women who underwent large-loop excision of the transformation zone (LLETZ). The impact of age, menopausal status, parity, high-risk human papillomavirus (hr-HPV) status, transformation zone (TZ) type, conization indications, and histopathological characteristics on cone volume, fragmentation, and margin status was assessed. Results: Cone volume was positively associated with increased parity and was significantly larger in women with resection margin involvement and complete lesion excision compared to those with unspecified margins. No significant correlations were found between cone volume and age, menopausal status, hr-HPV status, TZ type, indications for LLETZ, or specimen fragmentation. Specimen fragmentation demonstrated no correlations with parity, menopausal status, LLETZ indications, or hr-HPV status, but it was more prevalent among women aged 31–35 years. Absence of fragmentation was linked to clear resection margins, while fragmentation correlated with margin involvement. Complete excision was more frequent in women with high-grade squamous intraepithelial lesions (HSIL) cytology, although lesions extended to the specimen margin primarily in specimens with biopsy-confirmed HSIL cervical intraepithelial neoplasia (CIN) 3. None of the evaluated factors were independent predictors of complete lesion excision or margin involvement. Conclusions: Cone volume, fragmentation, and margin status are clinically relevant LLETZ outcomes, although no independent predictors were identified after adjustment. Larger prospective multicenter studies are needed to determine how oncologic adequacy can be balanced with preservation of cervical function.