Difference between revisions of "Loop electrosurgical excision procedure"

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==Negative LEEP==
==Negative LEEP==
Definition:
===Definition===
*LSIL or NILM, on a LEEP prompted by HSIL.<ref name=pmid23020732/>
*LSIL or NILM, on a LEEP prompted by HSIL.<ref name=pmid23020732/>


Prevalence:
===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>
*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>



Revision as of 04:56, 19 November 2013

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.

Negative LEEP

Definition

  • LSIL or NILM, on a LEEP prompted by HSIL.[2]

Prevalence

  • Relatively common ~ 25% of cases in one larger series.[2]

Work-up

  1. Review the biopsy that triggered the LEEP - check whether it is HSIL.
  2. Cut levels (x3) on all blocks.
  3. Flip all the blocks and cut levels (x3) on all the blocks.
  4. Do a p16 immunostain on the most suspicious block, if the triggering diagnosis was cannot exclude HSIL, HSIL or SCC.
  5. Sign out the thing as negative - see below.

Sign out

Negative LEEP

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.

See also

References

  1. URL: http://www.webmd.com/cancer/cervical-cancer/loop-electrosurgical-excision-procedure-leep-for-abnormal-cervical-cell-changes. Accessed on: 13 August 2012.
  2. 2.0 2.1 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.