Difference between revisions of "Loop electrosurgical excision procedure"
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'''Loop electrosurgical excision procedure''', abbreviated '''LEEP''', is a gynecologic procedure to remove tissue from the [[uterine cervix]].<ref>URL: [http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes]. Accessed on: | '''Loop electrosurgical excision procedure''', abbreviated '''LEEP''', is a gynecologic procedure to remove tissue from the [[uterine cervix]].<ref name=webmd>URL: [http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes]. Accessed on: 20 March 2014.</ref> It is used to diagnose, stage and treat cervical neoplasia. | ||
== | It is also known as '''large loop excision of the transformation zone''', abbreviated '''LLETZ'''.<ref name=webmd>URL: [http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes]. Accessed on: 20 March 2014.</ref><ref name=pmid22173237>{{Cite journal | last1 = Kenwright | first1 = D. | last2 = Braam | first2 = G. | last3 = Maharaj | first3 = D. | last4 = Langdana | first4 = F. | title = Multiple levels on LLETZ biopsies do not contribute to patient management. | journal = Pathology | volume = 44 | issue = 1 | pages = 7-10 | month = Jan | year = 2012 | doi = 10.1097/PAT.0b013e32834d7b5d | PMID = 22173237 }}</ref> | ||
===Negative LEEP=== | |||
LEEPs are often done together with an endocervical curettage, as the ECC adds significant amount of sensitivity for [[endocervical AIS]].<ref name=pmid9207802>{{Cite journal | last1 = Denehy | first1 = TR. | last2 = Gregori | first2 = CA. | last3 = Breen | first3 = JL. | title = Endocervical curettage, cone margins, and residual adenocarcinoma in situ of the cervix. | journal = Obstet Gynecol | volume = 90 | issue = 1 | pages = 1-6 | month = Jul | year = 1997 | doi = 10.1016/S0029-7844(97)00122-1 | PMID = 9207802 }}</ref> | |||
==Negative LEEP== | |||
===Definition=== | |||
*[[LSIL]] or [[NILM]], on a LEEP prompted by HSIL.<ref name=pmid23020732/> | |||
===Prevalence=== | |||
*Relatively common ~ 25% of cases in one larger series.<ref name=pmid23020732>{{Cite journal | last1 = Witt | first1 = BL. | last2 = Factor | first2 = RE. | last3 = Jarboe | first3 = EA. | last4 = Layfield | first4 = LJ. | title = Negative loop electrosurgical cone biopsy finding following a biopsy diagnosis of high-grade squamous intraepithelial lesion: frequency and clinical significance. | journal = Arch Pathol Lab Med | volume = 136 | issue = 10 | pages = 1259-61 | month = Oct | year = 2012 | doi = 10.5858/arpa.2011-0494-OA | PMID = 23020732 }}</ref> | |||
===Work-up=== | |||
#Review the biopsy that triggered the LEEP - check whether it is HSIL. | |||
#Cut levels (x3) on all blocks. | |||
#Flip all the blocks and cut levels (x3) on all the blocks. | |||
#Do a p16 [[immunostain]] on the most suspicious block, if the triggering diagnosis was ''cannot exclude HSIL'', ''HSIL'' or ''SCC''. | |||
#Sign out the thing as negative - see below. | |||
===Sign out=== | |||
<pre> | <pre> | ||
A. UTERINE CERVIX, LOOP ELECTROSURGICAL EXCISION PROCEDURE (LEEP): | A. UTERINE CERVIX, LOOP ELECTROSURGICAL EXCISION PROCEDURE (LEEP): | ||
| Line 16: | Line 33: | ||
COMMENT: | COMMENT: | ||
Levels were cut (x3) on all blocks. The blocks were flipped and an additional set of levels were cut on all blocks. | Levels were cut (x3) on all blocks. The blocks were then flipped and an | ||
additional set of levels (x3) were cut on all blocks. | |||
A p16 immunostain was done on A1. It does not demonstrate high-grade dysplasia. | A p16 immunostain was done on A1. It does not demonstrate | ||
high-grade dysplasia. | |||
The previous pathology was partially reviewed, and | The previous pathology was partially reviewed, and I have no significant | ||
disagreement with the findings. | |||
</pre> | </pre> | ||
====Not indicated==== | |||
<pre> | |||
COMMENT: | |||
In the context of the preceding tests, no additional levels were cut on the LEEP specimen. | |||
</pre> | |||
==See also== | ==See also== | ||
*[[Cervical intraepithelial neoplasia]]. | *[[Cervical intraepithelial neoplasia]]. | ||
*[[HSIL]]. | *[[High-grade squamous intraepithelial lesion]] (HSIL). | ||
*[[Negative prostatectomy]]. | |||
==References== | ==References== | ||
Latest revision as of 12:56, 1 May 2014
Loop electrosurgical excision procedure, abbreviated LEEP, is a gynecologic procedure to remove tissue from the uterine cervix.[1] It is used to diagnose, stage and treat cervical neoplasia.
It is also known as large loop excision of the transformation zone, abbreviated LLETZ.[1][2]
LEEPs are often done together with an endocervical curettage, as the ECC adds significant amount of sensitivity for endocervical AIS.[3]
Negative LEEP
Definition
Prevalence
- Relatively common ~ 25% of cases in one larger series.[4]
Work-up
- Review the biopsy that triggered the LEEP - check whether it is HSIL.
- Cut levels (x3) on all blocks.
- Flip all the blocks and cut levels (x3) on all the blocks.
- Do a p16 immunostain on the most suspicious block, if the triggering diagnosis was cannot exclude HSIL, HSIL or SCC.
- Sign out the thing as negative - see below.
Sign out
A. UTERINE CERVIX, LOOP ELECTROSURGICAL EXCISION PROCEDURE (LEEP): - ACUTE AND CHRONIC CERVICITIS. - BENIGN SQUAMOUS EPITHELIUM, METAPLASTIC SQUAMOUS EPITHELIUM, AND BENIGN ENDOCERVICAL GLANDS. - NEGATIVE FOR DYSPLASIA AND NEGATIVE FOR MALIGNANCY, SEE COMMENT. B. UTERINE ENDOCERVIX, CURETTAGE: - ENDOCERVICAL MUCOSA AND STRIPPED ENDOCERVICAL EPITHELIUM WITHIN NORMAL LIMITS. - BENIGN SQUAMOUS EPITHELIUM. - NEGATIVE FOR DYSPLASIA. COMMENT: Levels were cut (x3) on all blocks. The blocks were then flipped and an additional set of levels (x3) were cut on all blocks. A p16 immunostain was done on A1. It does not demonstrate high-grade dysplasia. The previous pathology was partially reviewed, and I have no significant disagreement with the findings.
Not indicated
COMMENT: In the context of the preceding tests, no additional levels were cut on the LEEP specimen.
See also
- Cervical intraepithelial neoplasia.
- High-grade squamous intraepithelial lesion (HSIL).
- Negative prostatectomy.
References
- ↑ 1.0 1.1 URL: http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes. Accessed on: 20 March 2014.
- ↑ Kenwright, D.; Braam, G.; Maharaj, D.; Langdana, F. (Jan 2012). "Multiple levels on LLETZ biopsies do not contribute to patient management.". Pathology 44 (1): 7-10. doi:10.1097/PAT.0b013e32834d7b5d. PMID 22173237.
- ↑ Denehy, TR.; Gregori, CA.; Breen, JL. (Jul 1997). "Endocervical curettage, cone margins, and residual adenocarcinoma in situ of the cervix.". Obstet Gynecol 90 (1): 1-6. doi:10.1016/S0029-7844(97)00122-1. PMID 9207802.
- ↑ 4.0 4.1 Witt, BL.; Factor, RE.; Jarboe, EA.; Layfield, LJ. (Oct 2012). "Negative loop electrosurgical cone biopsy finding following a biopsy diagnosis of high-grade squamous intraepithelial lesion: frequency and clinical significance.". Arch Pathol Lab Med 136 (10): 1259-61. doi:10.5858/arpa.2011-0494-OA. PMID 23020732.