title: A LEEP cervical conization is rarely indicated for a two-step discrepancy.
abstract: OBJECTIVE
  The current indications for conization of the cervix include a 2-step discrepancy between cervical cytological and histological findings. We sought to determine the utility of a loop electrocautery excision procedure (LEEP) cone for a 2-step discrepancy.
  
  
  METHODS
  A retrospective institutional review board-approved chart review was performed on all women recommended to undergo a LEEP secondary to a discrepancy between a referral high-grade squamous intraepithelial lesion cytological finding and a subsequent colposcopic biopsy result revealing either normal or cervical intraepithelial neoplasia (CIN) 1 histological finding; CIN 2 was excluded from the study. Statistical analysis was performed using SAS 9 (SAS Institute, Inc, Cary, NC). The results were considered significant if a p value less than or equal to.05 was demonstrated.
  
  
  RESULTS
  Fifty-nine patients received a LEEP for a 2-step discrepancy between cytological and histological findings. Twenty-seven patients had a second pass or LEEP cone. Among the patients with a normal cervical biopsy result and a high-grade cytological finding, 10 (29%) of 34 had normal histological findings, as revealed by LEEP, and 14 (41%) of 34 had CIN 3; 16 (64%) of 25 patients with high-grade cytological finding and CIN 1 biopsy finding had CIN 3, as revealed by LEEP. Compared with patients with an initial normal cervical biopsy result, those with CIN 1 on initial biopsy were more likely to have CIN 3 on their LEEP findings (p =.08). Twenty-seven of 59 patients underwent a LEEP cone surgery; 1 of 27 had CIN 3 finding in the second-pass portion. This was associated with a CIN 3 identified on the first pass and associated with positive margins. The second pass of the LEEP cone failed to demonstrate CIN 96% of the time (p < .0001). Patients with a normal or a CIN 1 finding on the first pass had a normal finding on the second pass in 100% of cases.
  
  
  CONCLUSIONS
  A LEEP cone is rarely indicated for the evaluation of a 2-step discrepancy. A randomized trial of this finding is warranted.
authors.affiliation: The University of Oklahoma Health Sciences Center, Oklahoma City, OK 73169, USA. grainger-lanneau@ouhsc.edu
authors.forename: Grainger S
authors.initials: GS
authors.lastname: Lanneau
authors.forename: Valerie
authors.initials: V
authors.lastname: Skaggs
authors.forename: Kathleen
authors.initials: K
authors.lastname: Moore
authors.forename: Sean
authors.initials: S
authors.lastname: Stowell
authors.forename: Rosemary
authors.initials: R
authors.lastname: Zuna
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gold
mesh_terms: D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy; D019092:Conization; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis