THE CASE FOR CYTOLOGIC FOLLOW-UP AFTER LEEP

OBJECTIVE: To examine our loop electrocautery excisional procedure (LE EP) biopsy experience to assess the incidence of abnormal follow-up an d relate this to margin status. STUDY DESIGN: Records of 162 LEEP proc edures performed between January 1992 and April 1994 were reviewed to evaluate margin readability and status. All follow-up cytologic or his tologic specimens were examined. RESULTS: After a mean 10.9-month foll ow-up, of 162 cases, 67 had a negative study (41.4%). Fifty-four (33%) had an abnormal result, with high grade squamous intraepithelial lesi on (HSIL) in 16 cases (13.2%) of all LEEPs with follow-up, low grade s quamous intraepithelial lesions in 27 (22.3%) and squamous atypia in 1 1 (9.1%). On microscopic review of these 54 cases, 37 had a readable m argin (68.5%); of these readable margins, 12 (32.4%) were positive. Fo rty-one cases (25.3% of all LEEPs) had no follow-up study. CONCLUSION: The high incidence of HSIL after LEEP highlights the need for vigilan t follow-up. Prediction of follow-up by margin status is dubious. Ther mal artifact makes the margin uninterpretable in many cases, and two-t hirds of cases with abnormal follow-up occurred where the LEEP margin was negative. Our finding of no follow-up for 25% of LEEPs performed i s particularly disturbing in light of these results.