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.

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.