Should endocervical excision and curettage be done during LEEP?

OBJECTIVE

To evaluate the need for routine endocervical sampling and endocervical curettage at the time of loop electrosurgical excision procedure (LEEP) in patients with satisfactory colposcopic assessment being treated for dysplasia.

STUDY METHODS

One hundred and eight patients having a satisfactory colposcopy referred for excision of their dysplasia with LEEP (four case) were studied. The procedure was carried out with a standard ectocervical excision to a depth of 6 mm and an endocervical excision centrally to a further 3 mm. An endocervical curettage was performed at the end of the procedure.

RESULTS

Of the 108 patients, 94 (87%) had a negative endocervical excision and endocervical curettage. Thirteen percent had a positive endocervical excision or endocervical curettage. Only 2 patients had endocervical pathology worse than the ectocervical pathology. There was no difference in the distribution of CIN I to CIN III in patients who had a negative endocervical excision or a positive endocervical excision. In the overall group, complications arose in 2.7% of patients and were minor and self-limiting. The overall long-term follow-up cure rate was 99% in the entire group.

CONCLUSIONS

Satisfactory colposcopy is not an adequate discriminant for the use of an ectocervical excision only for patients with dysplasia. Thirteen percent of patients would theoretically have had persistent disease if an endocervical excision was not performed. Adequate endo- and ectocervical excisions are an important component of the LEEP procedure and cannot be separated.