Apichaya Kuamanee, MD¹ , Sitchuphong Noothong, MD¹

Objective: To identify the factors affecting positive surgical margins from the loop electrosurgical excision procedure (LEEP) on the cervix. The secondary objective is to determine the optimal depth for LEEP on the cervix, resulting in no detectable lesions at the tissue margins.

Materials and Methods: The authors conducted a retrospective cohort study of those who underwent colposcopy and LEEP at Hatyai Hospital between November 2016 and August 2023. Statistical analyses, including univariate and multivariate logistic regression analyses, were performed to identify factors associated with positive surgical margins. The optimal depth of LEEP for achieving negative surgical margins was calculated using a receiver operating characteristic (ROC) curve.

Results: Two hundred thirty-seven patients were included; 115 (48.5%) had positive surgical margins, and 122 (51.5%) had negative surgical margins. Unsatisfactory colposcopy (adjusted OR 1.78, 95% CI 1.03 to 3.07), endocervical glandular involvement (aOR 2.90, 95% CI 1.62 to 5.19), and LEEP performed by residents (aOR 2.15, 95% CI 1.01 to 4.58) were associated with increased risk of positive surgical margins. The optimal depth of LEEP to achieve negative surgical margins is greater than 1.5 centimeters, with a sensitivity of 80.9%, a specificity of 27%, a positive predictive value of 51.1%, and a negative predictive value of 60%.

Conclusion: Unsatisfactory colposcopy, endocervical glandular involvement, and the surgeon’s factor are significantly associated with positive surgical margins. An excisional depth greater than 1.5 cm may increase the likelihood of negative surgical margins. Clinical practice guidelines should emphasize the importance of adequate colposcopy and the practitioner’s experience in reducing the incidence of positive surgical margins.

Received 4 October 2025 | Revised 14 April 2026 | Accepted 16 April 2026

J Med Assoc Thai 2026;109(10):816-22

DOI: 10.35755/jmedassocthai.2026.10.03651