Richard Hopley, M.D. | 12/01/2013Answering the above question may not be easy; you may have asked this yourself. For both the operating clinician and the examining pathologist, it is very satisfying to find a high grade squamous lesion within a cervical LEEP, which confirms the original diagnosis as well as provides a sense of closure to both parties. However, data shows that a negative LEEP following a biopsy diagnosis of high grade squamous dysplasia (CIN 2+) occurs between 14-17% of the time1. Assuming an adequately excised transformation zone, this may be due to:
- Biopsy removal of the lesion
- Destruction of the dysplasia by post-biopsy inflammation
A recent article2 sought to determine the actual frequency of a negative LEEP, as well as to study its clinical significance. 378 patients who underwent a LEEP procedure were selected, 306 of which had a diagnosis of CIN 2+ on biopsy. In this study, the findings were as follows:
- 76% of patients had CIN 2+ on the LEEP
- 24% patients showed CIN 1 or negative findings within the LEEP specimen
The recurrence data for these patients with CIN 2+, after LEEP is as follows:
- 13% of patients with high grade dysplasia in the LEEP had recurrent disease
- 10% of patients without high grade dysplasia in the LEEP had recurrent disease
Other studies3 show a similar pattern of recurrence, although with higher recurrence rates:
- 27% recurrence in patients with a LEEP with high grade dysplasia
- 24% recurrence in the patient group with a LEEP without high grade dysplasia
(Importantly, there is no statistical difference between these pairs of recurrence rates.) In addition, a very recent study4 noted that younger age (5 which showed as many as 89% of young patients had CIN 1 or no dysplasia on their excision specimen. In short, based on these results, patients with positive and negative LEEP findings should be treated and followed up similarly. 10-25% of LEEPs performed for a diagnosis of high grade squamous dysplasia will show recurrence of a high grade lesion during the subsequent follow up, regardless of the presence of dysplasia within the excision specimen (assuming adequate excision of the transformation zone.)
BIBLIOGRAPHY: 1 Negative cone biopsies: a reappraisal. Diakomanolis E, Haidopoulos D, Chatzipapas I, Rodolakis A, Stefanidis K, Markaki S. 2003, J Reprod Med, pp. 617-621. 2 Negative Loop Electrosurgical Cone Biopsy Finding Following a Biopsy Diagnosis of High Grade Squamous Intraepithelial Lesion; Frequency and Clinical Significance. Witt BL, Factor RE, Jarboe EA, Layfield LJ. 2012, Arch Pathol Lab Med, pp. 1259-1261. 3 The clinical significance of a negative loop electrosurgical cone biopsy for high-grade dysplasia. Livasy CA, Moore DT, Van Le L. 2004, Obstet Gynecol, pp. 250-254. 4 Nadim B, Beckmann M. Do we perform too many procedures for cervical dysplasia in young women? J Low Genit Tract Dis. 2013 Oct;17(4):385-9. 5 Case et al. Cervical intraepithelial neoplasia in adolescent women: incidence and treatment outcomes. Obstet Gynecol 2006; 108: 1369–74. Article written by PathAdvantage pathologist Richard Hopley, MD.