Understanding Your Colposcopy and LEEP Pathology Report

Section Editor: Jason Wasserman MD PhD FRCPC
November 4, 2026

A colposcopy is a close examination of the cervix using a magnifying instrument called a colposcope. It is usually done after an abnormal Pap test or a positive HPV test. During the colposcopy, your doctor may take small tissue samples called biopsies, or scrape cells from the canal of the cervix. A loop electrosurgical excision procedure (LEEP) removes a larger piece of the cervix, and it is often done after a biopsy shows a precancerous change.

A pathologist examines every sample removed during a colposcopy or LEEP under a microscope and writes a pathology report. Most of these reports describe either normal tissue or a precancerous change, rather than cancer. This article explains what your colposcopy or LEEP pathology report says, from the diagnosis to the margins. It also explains what each finding means for your follow-up.

What are the cervix and the transformation zone?

The cervix is the lower part of the uterus that opens into the vagina, and it is the organ examined during a colposcopy or LEEP. The outer part of the cervix, which faces the vagina, is called the ectocervix. It is covered by flat cells called squamous cells. The canal that runs through the center of the cervix is called the endocervix, and it is lined by mucus-making glandular cells.

The area where these two types of cells meet is called the transformation zone. In this zone, glandular cells are slowly replaced by squamous cells, a normal process called squamous metaplasia. Cells in the transformation zone are especially open to infection by high-risk types of human papillomavirus (HPV). For this reason, almost all cervical precancers and cancers start here, and it is the area your doctor examines most closely.

Why are colposcopy and LEEP performed?

Colposcopy and LEEP are performed to find and remove precancerous changes in the cervix before they can turn into cancer. These changes are almost always caused by a long-lasting infection with high-risk HPV. Most HPV infections clear on their own within a year or two. When an infection lasts longer, it can change how cervical cells grow.

During a colposcopy, the cervix is often coated with a mild vinegar solution, which makes abnormal areas turn white. Your doctor then takes biopsies from any area that looks abnormal. A colposcopy is mainly a diagnostic test because it shows whether precancerous changes are present and how severe they are.

A LEEP is both diagnostic and a treatment. It uses a thin wire loop, heated with an electric current, to remove the transformation zone in one or more pieces. Some doctors call the same procedure a large loop excision of the transformation zone (LLETZ). A cone biopsy removes a similar cone-shaped piece of the cervix using a scalpel or laser instead of a heated wire.

What samples are sent to the pathologist after a colposcopy or LEEP?

Several types of samples can be sent to the pathologist after a colposcopy or LEEP. Your report may describe one sample or several, and each one is usually labeled with a letter or number. The most common types are listed below.

Cervical biopsy. A small piece of tissue, usually 2 to 3 mm across, taken from an abnormal-looking area during colposcopy. Your report may list several biopsies, each labeled by its location on the cervix, such as “6 o’clock” or “12 o’clock.”
Endocervical curettage (ECC). Cells and small fragments of tissue scraped from inside the canal of the cervix. This sample checks for abnormal cells higher in the canal that the colposcope cannot see.
LEEP or LLETZ specimen. A larger, ring-shaped or cone-shaped piece of tissue that includes the transformation zone. It may arrive in one piece or in several pieces.
Top hat. A second, smaller piece taken from higher in the endocervical canal after the main LEEP piece is removed. It is sent separately and has its own margins.
Cone biopsy. A cone-shaped piece of the cervix removed with a scalpel or laser. It is often used when a larger or deeper sample is needed, such as for a glandular precancer.

How does the pathologist examine colposcopy and LEEP samples?

The pathologist first describes each colposcopy or LEEP sample without a microscope, in a part of the report called the gross description. This section lists the number of pieces and their size. For a LEEP or cone, it also records the specimen depth. It notes any stitch the surgeon used to mark its position, often placed at 12 o’clock.

For a LEEP or cone biopsy, the pathologist paints the cut surfaces with ink so the true tissue edges can be seen later under the microscope. The tissue is then cut into thin slices around the cervix, much like the numbers on a clock face. Usually, the pathologist examines all of the tissue so a small area of disease is not missed.

Under the microscope, the pathologist examines slides stained with hematoxylin and eosin (H&E). The key question is whether the squamous or glandular cells look normal, show a precancerous change, or show cancer. For a precancerous change, the pathologist also decides how much of the epithelium, the lining of the cervix, contains abnormal cells. In some cases, a special stain called p16 is used to confirm the diagnosis, as described below.

What diagnoses can appear on a colposcopy or LEEP pathology report?

The diagnoses on a colposcopy or LEEP pathology report fall into three main groups: normal or benign findings, precancerous changes, and cancer. Precancerous changes in squamous cells have two naming systems, and many reports use both. The squamous intraepithelial lesion (SIL) system uses two grades, low-grade and high-grade. The cervical intraepithelial neoplasia (CIN) system uses three grades, CIN1, CIN2, and CIN3. A report might say, for example, “HSIL (CIN3).”

Normal and benign findings

No dysplasia or no intraepithelial lesion. The tissue shows normal squamous and glandular cells with no precancerous change. A report may say “benign squamous and glandular mucosa,” “negative for dysplasia,” or “negative for intraepithelial lesion.” This is reassuring, although your doctor will compare it with your Pap and HPV results.
Chronic cervicitis. Long-term inflammation of the cervix, seen as immune cells in the tissue. Chronic cervicitis is very common, is usually not caused by a specific infection, and is not a precancerous change.
Squamous metaplasia. The normal replacement of glandular cells by squamous cells in the transformation zone. It is a healthy change, and seeing it tells the pathologist that the transformation zone was sampled.
Reactive changes. Reactive changes are cells that look slightly different because of irritation, inflammation, or healing. These changes are not precancerous.
Nabothian cyst or endocervical polyp. A Nabothian cyst is a small mucus-filled bump, and an endocervical polyp is a small growth from the canal. Both are common and noncancerous.

Precancerous changes

Low-grade squamous intraepithelial lesion (LSIL or CIN1). LSIL shows HPV infection with abnormal cells only in the lower third of the epithelium. Cells called koilocytes, which show the effect of HPV, are often seen. Most LSIL goes away on its own, and it has a low risk of becoming cancer.
High-grade squamous intraepithelial lesion (HSIL), CIN2. HSIL with CIN2 means abnormal cells fill up to two-thirds of the epithelium. CIN2 is a true precancer, but a meaningful share of cases go away without treatment, especially in younger people.
High-grade squamous intraepithelial lesion (HSIL), CIN3. HSIL with CIN3 means abnormal cells fill more than two-thirds, or all, of the epithelium. CIN3 is less likely to go away on its own and carries the highest risk of becoming cancer if left untreated. Older reports may call this “carcinoma in situ.”
Adenocarcinoma in situ (AIS). Adenocarcinoma in situ is a precancerous change in the glandular cells of the endocervix. It is less common than HSIL and harder to see during colposcopy, because it can sit higher in the canal.

The article on cervical intraepithelial neoplasia (CIN) explains the CIN grades in more detail.

Cancer

Superficially invasive squamous cell carcinoma. A very early cancer in which squamous cells have just broken through the base of the epithelium into the tissue beneath it, called the stroma. Superficially invasive cancer is measured in millimeters and is often found only under the microscope.
Invasive squamous cell carcinoma. The most common type of cervical cancer. Most cases are HPV-associated squamous cell carcinoma, and a smaller number are HPV-independent.
Adenocarcinoma. A cancer that starts from the glandular cells of the endocervix. Most cervical adenocarcinomas are HPV-associated, and a smaller number are HPV-independent types.

Immunohistochemistry: p16 and Ki-67

In a colposcopy or LEEP sample, the pathologist may order immunohistochemistry, a test that uses antibodies to show specific proteins in the cells. These stains help confirm whether a precancerous change is present and how severe it is. They are most useful when the cells could be either CIN2 or a harmless look-alike, such as cells thinned by age or irritated by inflammation. The results may appear on your report as follows.

p16 positive (block-type or diffuse). p16 is a protein that builds up in cells infected by high-risk HPV that are growing abnormally. Strong staining in a continuous band across the lower epithelial layers supports a diagnosis of HSIL. Under the 2012 Lower Anogenital Squamous Terminology (LAST) recommendations, a positive p16 result supports HSIL only when the cells also look like CIN2 or CIN3.
p16 negative or patchy. No staining, or scattered weak staining, does not support HSIL. In a sample that looked like it might be CIN2, a negative p16 result usually means the change is reported as LSIL or as benign.
Ki-67. Ki-67 marks cells that are actively dividing. Normally, these cells sit only at the very bottom of the epithelium. Dividing cells higher in the epithelium support a precancerous change.

Not every colposcopy or LEEP sample needs these stains. Many diagnoses are clear on the routine slides alone, and the stains used vary between laboratories.

Endocervical curettage (ECC) results

An endocervical curettage (ECC) scrapes cells from inside the canal of the cervix, often during a colposcopy or just after a LEEP. Because the sample arrives as small loose fragments, the ECC report uses some wording of its own. The common results are listed below.

Negative or benign endocervical tissue. Normal glandular cells and mucus, with no precancerous change. This suggests there is no hidden disease higher in the canal.
Scant or insufficient sample. Very little tissue was collected, or the sample was mostly mucus or blood. The report may say “insufficient for diagnosis” or “limited for evaluation.” This does not mean disease was found, but it means the canal could not be fully assessed.
Detached fragments of LSIL or HSIL. Small loose pieces of precancerous squamous tissue were found. Because the fragments are loose, the pathologist cannot always tell whether they came from inside the canal or from the outer cervix.
AIS or cancer. Rarely, an ECC shows adenocarcinoma in situ or cancer. This result usually leads to further assessment with a larger excision.

LEEP and cone biopsy findings: location and extent

A LEEP or cone biopsy report describes where the precancerous change or cancer is found, as well as what it is. When the specimen arrives in one oriented piece, the report may give the location using a clock face, such as “HSIL (CIN3) involving 2 to 5 o’clock.” The report may also state how many slices contain the change, which gives a sense of its size.

Sometimes a LEEP or cone shows no precancerous change at all, even though an earlier biopsy did. A report may say “no residual dysplasia” or “no high-grade lesion identified.” This is a common result. It can mean the biopsy removed the whole area, the change went away on its own, or the heated loop destroyed the last abnormal cells.

Heat from the LEEP wire can damage the cells at the edges of the tissue, a change called cautery artifact. When the damage is severe, the pathologist may not be able to say what the cells at the edge are. The report will usually mention cautery artifact if it affects the diagnosis or the margins.

Surgical margins

A margin is a cut edge of the tissue removed during a LEEP or cone biopsy. Margins are reported for LEEP and cone specimens because the goal of these procedures is to remove the whole precancerous area. Margins are not usually reported for small colposcopy biopsies, which are meant to sample an area rather than remove it.

The current College of American Pathologists (CAP) protocol for cervical excision specimens (version 4.4.2.0, 2023) names three margins. Your report will say whether each one is involved, and by which change.

Ectocervical margin. The outer edge of the specimen, which faced the vagina.
Endocervical margin. The inner edge, which faced upward into the cervical canal. If a top hat was removed, it has its own endocervical margin, which becomes the final one.
Deep (stromal) margin. The cut surface in the deeper tissue of the cervix.

Each LEEP or cone margin is then described using one of the terms below.

Negative margin. No precancerous change or cancer reaches the edge. When invasive cancer is present, the report also gives the distance from the cancer to the closest margin, often in millimeters.
Positive margin. HSIL, AIS, or cancer reaches the inked edge. The report names which margin is involved and, sometimes, how much. A positive margin increases the risk that some precancer remains in the cervix, and it is considered when planning follow-up.
Cannot be determined. The pathologist cannot tell whether the margin is involved. This usually happens when cautery artifact damages the edge or when the tissue arrives in several pieces that cannot be oriented.

LSIL at a margin is often mentioned but carries little added risk, because LSIL commonly goes away on its own. HSIL or AIS at the endocervical or deep margin matters most, because that is where any remaining disease would sit inside the canal.

Findings reported when cervical cancer is found

When a colposcopy or LEEP sample shows invasive cervical cancer, the pathology report includes measurements that help your care team stage it. A LEEP or cone often provides the first accurate measurement of a very early cancer.

Depth of invasion. How far the cancer has grown below the epithelium, measured in millimeters. In the current FIGO staging system (2018, updated in 2021), stage IA1 means invasion of 3 mm or less. Stage IA2 means more than 3 mm but no more than 5 mm.
Horizontal extent. The width of the cancer, measured in millimeters. FIGO removed width from staging in 2018, so older reports and articles may mention a 7 mm width limit that no longer changes the stage. Some laboratories still report it.
Lymphovascular invasion. Lymphovascular invasion means cancer cells were seen inside small blood vessels or lymphatic channels. It increases the chance that the cancer has spread to lymph nodes.
Margins. The distance from the cancer to each margin, as described above.
HPV status. A p16 stain or HPV test on the tissue may show whether the cancer is HPV-associated. Without one of these tests, a report may simply say “squamous cell carcinoma.”

The pathology report does not assign the final stage by itself. Your care team combines these measurements with a pelvic examination and imaging to decide the stage.

What is the risk of a cervical precancer coming back?

After treatment with LEEP or cone biopsy for HSIL, most people never have the precancer come back. A large 2017 review in The Lancet Oncology found that about 4 in 100 people with negative margins later had HSIL again. A positive margin raised that risk nearly fivefold.

A follow-up HPV test is an even stronger guide than the margins. In the same review, people whose HPV test was negative after treatment had a risk of less than 1 in 100. For this reason, follow-up after a LEEP relies mainly on HPV testing, and the margin result is one part of that plan.

The factors that most affect the risk of a cervical precancer coming back are listed below.

Margin status. HSIL or AIS at the endocervical or deep margin carries more risk than disease at the ectocervical margin, or than negative margins.
Persistent HPV infection. A positive HPV test after treatment is the strongest sign that disease may remain or return.
Type of precancer. AIS is more likely than HSIL to extend higher into the canal or to appear in more than one spot.
Immune status. People with a weakened immune system, including those living with HIV or taking medicines after an organ transplant, clear HPV less easily.

What happens after a colposcopy or LEEP pathology report?

The next steps after a colposcopy or LEEP pathology report depend mainly on the diagnosis and the margins. Your age and your earlier Pap and HPV results also matter. In the United States, most care teams follow the 2019 ASCCP Risk-Based Management Consensus Guidelines, which have been updated several times since. Canadian provinces and other countries use their own programs, which are similar but not identical.

Benign result or LSIL (CIN1). Under the 2019 ASCCP guidelines, observation with repeat HPV-based testing is preferred over treatment for CIN1. Consider treatment if CIN1 persists for 2 years or more.
HSIL (CIN2 or CIN3). Treatment, usually with a LEEP or cone biopsy, is the most common approach. For CIN2, observation with repeat colposcopy may also be considered, especially for people under 25 or those concerned about effects on a future pregnancy.
After treatment for HSIL. The 2019 ASCCP guidelines describe HPV-based testing at 6 months, then yearly for 3 years. Testing then continues every 3 years for at least 25 years. A positive margin may lead your team to plan closer testing or, in some cases, a repeat procedure.
Adenocarcinoma in situ (AIS). AIS is usually removed in one intact piece so the margins can be checked. When margins are positive, ASCCP prefers a repeat excision. For people who have finished having children, a simple hysterectomy is often discussed next. People who want a future pregnancy may be followed closely instead, if the margins and ECC were negative.
Invasive cancer. A diagnosis of cancer usually leads to referral to a gynecologic oncologist and imaging to stage the cancer. Treatment options depend on the stage, and they are described in the diagnosis articles linked above.

Your care team will use your pathology report, along with your other test results, to plan your follow-up. The results of an HPV test done several months after treatment often guide what happens next.

Questions to ask your doctor

What did my colposcopy biopsies show, and where on the cervix were they taken?
Was my result LSIL, HSIL, or something else, and what CIN grade was it?
Was a p16 stain done, and what did it show?
Did my endocervical curettage show any abnormal cells, or was it insufficient?
Did my LEEP or cone specimen arrive in one piece or several?
Were the ectocervical, endocervical, and deep margins negative?
If a margin was positive, which one, and what change was at the margin?
Did cautery artifact make any margin impossible to assess?
What does “no residual dysplasia” in my LEEP mean for me?
When should I have my next HPV or Pap test?
Do I need a repeat LEEP, or can I be followed with testing?
How might this procedure affect a future pregnancy?