Loop electrosurgical excision procedure

Loop electrosurgical excision procedure, abbreviated LEEP, is a gynecologic procedure to remove tissue from the uterine cervix. It is used to diagnose, stage and treat cervical neoplasia.

It is also known as large loop excision of the transformation zone, abbreviated LLETZ.

Negative LEEP

Definition

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

Prevalence

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

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

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.
• HSIL.