title: Negative loop electrosurgical cone biopsy finding following a biopsy diagnosis of high-grade squamous intraepithelial lesion: frequency and clinical significance.
abstract: BACKGROUND
  Loop electrosurgical excision procedure (LEEP) is a therapeutic option following biopsy diagnosis of high-grade squamous intraepithelial lesion (HSIL). Most LEEPs will confirm the HSIL biopsy diagnosis but a number of them will not. Such negative findings suggest the possibility of an incorrect biopsy diagnosis, removal of the lesion by biopsy, or insufficient LEEP sampling.
  
  
  OBJECTIVE
  To determine the frequency of negative LEEP findings following HSIL biopsies and better understand the clinical significance of negative LEEP findings.
  
  
  METHODS
  The Department of Pathology's records were searched for all patients undergoing LEEP excision who had prior cervical biopsies and subsequent clinical follow-up.
  
  
  RESULTS
  Three hundred seventy-eight women were found who had index biopsies, subsequent LEEPs, and clinical follow-up averaging 25.8 months. Three hundred six women had HSIL on biopsy with 223 (73%) showing HSIL on LEEP. Seventy-three (24%) LEEPs in women with HSIL index biopsy results yielded negative findings or disclosed low-grade squamous intraepithelial lesion (LSIL). Twenty-nine of 223 patients (13%) with an HSIL result both on biopsies and LEEPs had HSIL on biopsy and/or excisional clinical follow-up. Seven of 73 patients (10%) with positive (HSIL) biopsy results but negative LEEP findings or LSIL had HSIL on biopsy and/or excisional follow-up.
  
  
  CONCLUSIONS
  Twenty-four percent of patients with HSIL on biopsy had negative findings or LSIL on LEEP. There is no statistical difference in development of HSIL after LEEP for those with positive biopsy and positive LEEP results (13%) versus positive biopsy and negative LEEP results (10%). The occurrence of a negative LEEP finding following a positive biopsy finding was frequent (24%) and does not portend a different clinical follow-up from a positive biopsy and positive LEEP result.
authors.affiliation: University of Utah School of Medicine and the RUP Laboratories, Salt Lake City, UT, 84112, USA. layfiel@aruplab.com
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Witt
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Factor
authors.forename: Elke A
authors.initials: EA
authors.lastname: Jarboe
authors.forename: Lester J
authors.initials: LJ
authors.lastname: Layfield
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D004598:Electrosurgery / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*