The case for cytologic follow-up after LEEP

OBJECTIVE: To examine our loop electrocautery excisional procedure (LEEP) biopsy experience to assess the incidence of abnormal follow-up and relate this to margin status. STUDY DESIGN: Records of 162 LEEP procedures performed between January 1992 and April 1994 were reviewed to evaluate margin readability and status. All follow-up cytologic or histologic specimens were examined. RESULTS: After a mean 10.9-month follow-up, of 162 cases, 67 had a negative study (41.4%). Fifty-four (33.3%) had an abnormal result, with high grade squamous intraepithelial lesion (HSIL) in 16 cases (13.2%) of all LEEPs with follow-up, low grade squamous intraepithelial lesions in 27 (22.3%) and squamous atypia in 11 (9.1%). On microscopic review of these 54 cases, 37 had a readable margin (68.5%); of these readable margins, 12 (32.4%) were positive. Forty-one cases (25.3% of all LEEPs) had no follow-up study. CONCLUSION: The high incidence of HSIL after LEEP highlights the need for vigilant follow-up. Prediction of follow-up by margin status is dubious. Thermal artifact makes the margin uninterpretable in many cases, and two-thirds of cases with abnormal follow-up occurred where the LEEP margin was negative. Our finding of no follow-up for 25% of LEEPs performed is particularly disturbing in light of these results.