Negative for Dysplasia in Loop Electrosurgical Excision Procedure (LEEP) and Cold Knife Cone Biopsy: Review of 380 Cases
Nguyen T Vo, Songlin Zhang. Louisiana State University Health Sciences Center, Shreveport, LA
Background: Loop electrosurgical excision procedure (LEEP) and cone are often used for treatment of high-grade cervical intraepithelial lesions (CIN 2+). Pathologists sometimes see the complete absence of dysplasia in a LEEP or cone specimens during their practice. There are several hypotheses to explain the absence of dysplasia, such as postbiopsy regression and small foci of dysplasia not sampled in the histologic sections. However, very few publications in the literature address the negative for dysplasia rate in LEEP and cone.
Design: LEEP and cone cases were retrieved from the database of Department of Pathology during January 1, 2008 to December 31, 2010. Cases without previous in-house tissue (biopsy or cytology) of high-grade intraepithelial lesions (HSIL) were excluded. Fisher exact and student t tests were used for statistic analysis.
Results: A total of 451 cases of LEEP and cone biopsies (257 cases of LEEP and 194 cone biopsies) were reviewed. 71 cases were excluded due to lacking in-house tissue of HSIL and/or CIN2+. Of the 380 studied cases, 219 LEEP and 161 cone, patients received cone biopsy were statistically older than patients with LEEP (37.2 vs 29.3 year-old, p=0.0001). 24 cases were negative for dysplasia (24/380, 6.3%) and there was no significant difference (p=0.67) between LEEP (15/219, 6.8%) and cone (9/161, 5.6%). 65/380 cases had only HSIL cytology without biopsy confirmed CIN2+. The negative for dysplasia was higher in cytology cases than those with biopsy confirmed CIN2+ (7/65 vs. 17/215), but it was not statistically significant (p=0.09). Reviewing the previous cervical biopsy or cytology of the 24 negative for dysplasia cases confirmed HSIL/CIN2+ in 22 cases and LSIL/CIN1 in the remaining 2 cases.
Conclusions: Negative for dysplasia in LEEP or cone is not an uncommon finding in daily practice, and the negative for dysplasia rate in our study was 6.3% (5.6% for cone and 6.8% for LEEP), which is lower than literature reports (14% -16.5%). Based on our study, misinterpretation of previous biopsy or cytology was an unlikely contributing factor for the negative LEEP and cone. Our results also support the current treatment guideline for HSIL cytology-the “see and treat” approach without biopsy confirmation of CIN2+.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 129, Wednesday Morning