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.[1] It is used to diagnose, stage and treat cervical neoplasia.

Negative LEEP

Definition

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.

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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 previous pap tests and ECC, no additional levels were 
cut on the LEEP specimen.

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. Jump up to: 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.