Negative Loop Electrosurgical Cone Biopsy Following a Biopsy Diagnosis of High-Grade Squamous Intraepithelial Lesion: Frequency and Clinical Significance
Benjamin L Witt, Rachel E Factor, Elke A Jarboe, Lester J Layfield. University of Utah School of Medicine, Salt Lake City, UT; ARUP Laboratories, Salt Lake City, UT
Background: Loop electrosurgical excision procedure (LEEP) is a therapeutic option following a biopsy diagnosis of high-grade squamous intraepithelial lesion (HSIL). Most LEEPs confirm the HSIL biopsy diagnosis but some will not show HSIL or carcinoma. Such negative findings suggest the possibility of an incorrect biopsy diagnosis, removal of the lesion by biopsy or insufficient LEEP sampling. We studied a series of LEEPs to determine the frequency of negative LEEPs after HSIL biopsies and the clinical follow-up of these negative LEEPs.
Design: The Department of Pathology's records were searched for all patients undergoing LEEP who had prior cervical biopsies and subsequent clinical follow-up.
Results: Three hundred seventy-eight women were found who had index cervical biopsies, subsequent LEEPs and clinical follow-up. Clinical follow-up averaged 25.8 months. Three hundred seven women had HSIL on biopsy with 234 (76%) showing HSIL or carcinoma on LEEP and 73 (24%) LEEPs being negative or disclosing low-grade squamous intraepithelial lesion (LSIL) on LEEP. Thirty-two of 223 (14%) patients with HSIL biopsies and LEEPs had HSIL on clinical follow-up. Eight of 73 (11%) patients with HSIL biopsies but negative or LSIL LEEPs had HSIL on follow-up.
Conclusions: Twenty-four percent of patients with HSIL biopsies are negative or LSIL on LEEP. There is no statistical difference in development of HSIL after LEEP for those with positive biopsies and LEEPs (14%) versus positive biopsies and negative LEEPs (11%). A negative LEEP following a positive biopsy is frequent (24%) and does not predict a different clinical follow-up than a positive biopsy and positive LEEP.
Category: Gynecologic & Obstetrics
Wednesday, March 21, 2012 9:30 AM
Poster Session V # 128, Wednesday Morning