What is a loop electrosurgical excision procedure (LEEP)?


Loop electrosurgical excision procedure (LEEP) is a treatment that removes abnormal tissue from the cervix using a thin wire loop that carries an electrical current. The cervix is the lower part of the uterus that connects to the vagina. LEEP is both a treatment and a method for obtaining tissue for microscopic examination.

Why is LEEP performed?

Doctors usually recommend LEEP after a Pap test or biopsy shows abnormal cells on the cervix. These abnormal cells are often described as precancerous changes, such as cervical intraepithelial neoplasia (CIN) or squamous intraepithelial lesion (SIL). Removing this tissue lowers the risk of developing cervical cancer.

How is LEEP performed?

LEEP is usually done in a doctor’s office or clinic. A thin wire loop is used to remove a small portion of tissue from the cervix. The wire heats up when an electrical current passes through it, allowing it to cut and seal blood vessels at the same time. Local anesthesia is often given to numb the area, and the procedure usually takes only a few minutes.

What happens to the tissue after LEEP?

After the LEEP procedure, the removed tissue is carefully labeled and sent to a pathology laboratory for examination. A pathologist then examines the tissue under a microscope to provide important information about the health of the cervix. The tissue is sliced into thin sections, placed on glass slides, and stained with special dyes so the pathologist can see the cells clearly.

Your pathology report after a LEEP will usually include:

  • The type of cells present: The pathologist looks to confirm whether the cells are normal, precancerous, or cancerous.

  • The grade of the abnormal cells: Abnormal cells are classified as either low grade or high grade, depending on how different they appear from normal cells and their likelihood of progressing to cancer.

  • The extent of the abnormal changes: The pathologist examines how much of the tissue is affected by abnormal cells.

  • The status of the margins: The report will indicate whether the abnormal cells extend to the edges of the removed tissue (the margins). If the edges are clear, it usually means the abnormal cells were removed entirely. If abnormal cells are present at the margins, there is a higher chance that some abnormal tissue remains in the cervix.

This information helps guide follow-up care and determine whether additional treatment is needed.

Conditions that may be diagnosed after a LEEP

LEEP is not only a treatment but also a diagnostic tool. Examining the removed tissue allows doctors to confirm the exact condition affecting the cervix. The most common conditions diagnosed after LEEP are:

  • Cervical intraepithelial neoplasia (CIN): CIN is a precancerous condition that is divided into grades 1, 2, and 3, based on how abnormal the cells look under the microscope. CIN 1 is considered low grade, while CIN 2 and CIN 3 are considered high grade with a higher risk of progressing to cancer if untreated.

  • Squamous intraepithelial lesion (SIL): SIL is another way of describing abnormal squamous cells on the cervix. It is divided into low grade (LSIL) and high grade (HSIL). LEEP is usually recommended for HSIL.

  • Adenocarcinoma in situ (AIS): AIS is a precancerous change involving glandular cells of the cervix. It carries a higher risk of developing into cervical adenocarcinoma if not removed.

  • Squamous cell carcinoma (SCC): Squamous cell carcinoma is a type of cancer that evolves from HSIL.

  • Adenocarcinoma: LEEP may also diagnose adenocarcinoma, a type of cervical cancer that begins in the glandular cells lining the cervix.

  • Benign (noncancerous) conditions: Occasionally, the tissue may show changes caused by inflammation, infection, or healing. These are not cancer and may explain abnormal Pap test results in some people.

By identifying the exact type of abnormality present, LEEP helps doctors plan the safest and most effective follow-up care.

Is a LEEP only performed for cancer?

No. In fact, most LEEP procedures are performed for precancerous conditions rather than cancer. The goal is to remove abnormal cells before they have a chance to develop into cervical cancer. LEEP can also be used to confirm the diagnosis when earlier tests suggest abnormal changes.

Can a LEEP remove all of the abnormal tissue?

Yes, in many cases, LEEP completely removes the abnormal cells. However, sometimes the abnormal cells extend to the edges of the removed tissue, meaning some abnormal tissue may remain. If this happens, your doctor may recommend close follow-up or another treatment to ensure all abnormal cells are removed.

What is the chance of recurrence after a LEEP?

The chance of abnormal cells returning after a LEEP is low, especially if the abnormal tissue is completely removed. Regular follow-up with Pap tests and HPV testing is necessary because a small number of people can develop new abnormal cells on the cervix in the future.

What are the risks of LEEP?

Most people recover quickly after LEEP. Some risks include light bleeding, infection, or scarring of the cervix. Rarely, repeated procedures can increase the chance of problems with pregnancy, such as preterm birth.

Questions to ask your doctor

  • Were all the abnormal cells removed?

  • Will I need more treatment or only follow-up?

  • How often should I have follow-up Pap tests or HPV tests?

  • Could LEEP affect future pregnancies?

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