Comparing loop electrosurgical procedure pathology results in the inpatient and outpatient setting (474)

Abstract

<b>Objectives:</b> In the management of cervical intraepithelial neoplasia (CIN), loop electrosurgical excision procedure (LEEP) provides diagnostic information and may be therapeutic. Margin status is a key prognostic factor, given that patients with positive margins demonstrate a five-fold increased risk of any grade CIN recurrence. LEEP can be safely performed in inpatient or outpatient settings as dictated by patient preference, equipment availability, and anatomic considerations. However, there is limited evidence comparing outcomes as they relate to the LEEP treatment settings. We sought to evaluate quality outcomes and margin status of inpatient versus outpatient LEEPs. <b>Methods:</b> All patients who underwent LEEP between April 2019 and August 2021 at a single institution were identified. Chart review was conducted to extract patient demographics, clinical risk factors, and pathology outcomes. Mann-Whitney U and Chi-square tests were used for statistical analysis. <b>Results:</b> We analyzed 291 LEEP specimens, 254 (87%) in the outpatient setting and 37 (13%) in the inpatient setting. Table 1 lists patient characteristics and pathologic outcomes data. There was a significant difference in the median age, BMI, and parity between the two groups. The reasons for inpatient LEEP listed were difficult anatomy (<i>n</i>=12, 32%), lack of access to equipment required for LEEP (<i>n</i>=11, 30%), patient preference (<i>n</i>=4, 11%), concern for malignancy (<i>n</i>=3, 8%), patient comorbidity (<i>n</i>=3, 8%), large area of dysplasia (<i>n</i>=2, 5%), and combined case with other inpatient procedure (<i>n</i>=2, 5%). All comorbid conditions were related to bleeding disorders. There were significant differences between colposcopy and LEEP pathology results with respect to grade of dysplasia and evidence of malignancy. No significant differences were identified with respect to the frequency of thermal artifact affecting pathologic interpretation of margin status. Interestingly, LEEPs performed in the inpatient setting were associated with greater specimen depth and multiple tissue samples (not including endocervical curettage) compared to outpatient LEEPs. <b>Conclusions:</b> In this single-institution, retrospective study, there was no significant difference between inpatient and outpatient LEEP procedures with respect to the thermal artifact and margin status. This may result from the more ubiquitous use of P16 immunohistochemical staining to evaluate specimen margins. Although the depth of the resected specimen was significantly greater when performed in the operating room, there was also an apparent increase in specimen number, potentially reflecting larger visible lesions requiring multiple resections. These results suggest that outpatient LEEP procedures may be equally effective in managing CIN, with potential cost implications.