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: 13 August 2012.</ref>  It is used to diagnose, stage and treat cervical neoplasia.
'''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.


==Sign out==
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 there is no significant disagreement.
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

  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

References

  1. 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.
  2. 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.
  3. 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. 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.