The indications for LEEP treatment of exocervical lesions are similar to those for cryotherapy and laser. Any biopsy proven CIN lesion with an adequate colposcopy can be treated with LEEP. Note that HPV infection without evidence of dysplasia is not an indication for LEEP. Relative costs for cervical dysplasia treatments are shown in Table 3.
LEEP vs Cryotherapy. Cryotherapy has the advantage of being fast and technically easy, with less expensive equipment and minimal set-up time. LEEP has greater precision of treatment depth and provides a histologic specimen for analysis. LEEP may also preserve the SCJ better than cryotherapy although a flat cryotherapy probe improves future satisfactory SCJs. 20 LEEP and cryotherapy have similar cervical stenosis rates and similar cure rates for CIN 1 and 2. Many centers now recommend using LEEP for high-grade lesions because of the risk of deeper crypt involvement. LEEP can also be used for dysplasia deemed inappropriate for cryotherapy, such as large lesions not fitting beneath a cryotherapy probe. Otherwise, the modality used is often a matter of personal preference.
LEEP vs Laser. LEEP is technically easier and involves less expensive equipment. 5 Both LEEP and laser conization produce a histologic specimen for analysis and cause minimal tissue damage. 21 Standard laser therapy destroys the tissue. Both procedures produce similar cure rates for all grades of CIN. 22 Although there is no difference in discomfort induced by LEEP and laser, LEEP takes significantly less time to perform. 23 There is also evidence that recurrence of CIN after LEEP may be less than with laser therapy. 10 The modality used is often a matter of personal preference.
LEEP conizations. Most centers are performing LEEP conizations for diagnosis and treatment of lesions extending more than 5 mm into the cervical canal, when the colposcopy is inadequate, or when the ECC is positive. 24 It is also commonly used after cryotherapy failures, especially if the subsequent colposcopy is unsatisfactory. An unresolvable biopsy-Pap smear or biopsy-impression mismatch also may be treated with LEEP conization once vaginal and vulvar sources of disease are ruled out. 25 Some practitioners are also using LEEP conization for microinvasive disease, but this is not generally accepted. 24
Table 3. Relative costs for treatments for cervical dysplasia. (Source: 1995 Physicians Fee and Coding Guide. Healthcare Consultants of America 1995.)
Treatment CPT Code Range ($) Avg ($) ----------------------------------------- Cryotherapy 57511 170-202 186 LEEP 57460 575-710 465 Laser 57513 756-910 833
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