THE PREDICTIVE VALUE OF LEEP SPECIMENS WITH INVOLVED MARGINS FOR RESIDUAL DYSPLASIA

The objective of this study was to determine the percentage of loop el ectrosurgical excision procedure (LEEP) specimens with involved margin s; also to determine factors associated with involved margins and the rate of residual dysplasia in the cervix post-LEEP. One hundred and si xty-nine women underwent LEEP excision of the cervix using standard te chniques. Data concerning indications, complications, associated clini cal factors, and histopathologic results were collected. Patients with involved specimen margins were examined for the presence of residual dysplasia 3 months post-LEEP. Thirty-one out of 131 (23.6%) specimens with histologically confirmed preinvasive disease had margins involved with dysplasia. Risk factors associated with margin involvement inclu de referral Papanicolaou (Pap) smear result of high-grade squamous int ra-epithelial lesion (SIL) (28/56) vs low-grade SIL (3/75) (P<0.0001), and human immunodeficiency virus (HIV) infection (3/3 with involved m argins). Whether the LEEP was performed at initial visit (Look and LEE P) or following traditional colposcopy/biopsy did not affect the invol ved margin rate. Only 18% (4/22) patients with involved margins had ev idence of residual dysplasia, none with worse disease than the initial specimen. High-grade SIL on referral Pap, and HIV infection are risk factors for involved specimen margins. Additional treatment of patient s with involved LEEP margins may be deferred, as more than 80% of pati ents will have no residual dysplasia at 3 months post procedure.