E.J. Mayeaux, Jr., M.D.
Associate Professor of Family Medicine
Clinical Associate Professor of Obstetrics and Gynecology
Louisiana State University Medical Center - Shreveport, Louisiana
Patients are instructed to return for pathology results when they will be available to the physician. Since many pathologists do not make "breadloaf" cuts of cervical specimens and could miss small internal lesions, a report that shows no dysplasia should be interpreted that the sample had a clear margin, not that there is no dysplasia present. Patients with no dysplasia involved with the resection margins may be followed-up for 2 years with Pap smears and/or colposcopy every 6 months. If all tests remain normal, routine yearly screening may be resumed (the patient is now permanently high-risk for developing cervical dysplasia.) Any sign of recurrence requires recolposcopy.
Since the recurrence rate with positive margins is between 10% and 55%, positive margins on the LEEP specimen DO NOT require immediate retreatment, as many patients are adequately treated (Table 4.) A positive endocervical curettage after LEEP cone or LEEP procedure may be treated the same as a positive endocervical margin since it indicates the possibility of residual dysplasia. 28 - 30 These patients should have close follow-up, usually with colposcopy with directed biopsy and ECC. 29 It is important to check for recurrences deep in the os ("skip lesions") and along the edge of the original LEEP cut. Patients with biopsy proven recurrent lesions should be offered retreatment or hysterectomy.
Table 4. Recurrence rates for single LEEP procedures
with positive margins from the English language literature.
Ref # in Recurrence Time in Follow-up
Study Rate Follow-up Test
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6 53 54.7% 4 months Colpo
7 256 10% 3 months Pap / Colpo
8 8 25% 6 months Pap / Colpo
9 53 33% < 2 years Pap
31 20 75% 4-6 months Colpo
34 53 45.3% 8 months Colpo
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