Effects of Mefenamic Acid in Pain Control during Loop Electrical Excision Procedure:A Prospective Double-Blind Randomized Control Trial.

HIGHLIGHTS Clinicopathologic characteristic of patient with LEEP procedures dominated by women above 35 years old, with total parity less than 3 and without history of contraceptive usage. The p16 expression analyzed by immunohistochemistry technique. The positive and negative reactivity of p16 ratio was 3:5 on LEEP specimen which microscopically appear as chronic cervicitis, low-grade and high-grade squamous intraepithelial lesion. ABSTRACT Objective: The study aim was to reveal p16 expression with the clinicopathological characteristics of patients who underwent cervical biopsy using the Loop electrosurgical procedure (LEEP) at Udayana University Hospital for the period 2020 – 2023. Materials and Methods: The research was conducted at Anatomic Pathology Laboratory of Udayana University Hospital, Denpasar, Bali, Indonesia. The samples were selected based on inclusion criteria such as the formalin fixed paraffin embedded (FFPE) sample from positive IVA patient and continue for LEEP procedure. Otherwise, the exclusion criteria were moldy FFPE sample and incomplete clinical data. Then, p16 immunostaining procedure was carried out manually. The interpretation of p16 results was analyzed using SPSS software, version 25 by International Business Machines (IBM) Corporation. Results: The positive p16 expression was revealed in 12 samples (38.7%), in contrast the negative staining appeared in 19 samples (61.3%). Unfortunately, p16 expression was not significant statistically based on age, parity, and contraceptive history, with p-values of 1.00, 0.45, and 0.65, respectively. Meanwhile, a statistically significant association was found between p16 expression and histopathologic diagnostic (p = 0.02, 95% CI 1.4 – 38.3). In addition, 22.2% of the variation of p16 expression based on multivariate analysis demonstrating a significant correlation (p = 0.01). Conclusion: p16 expression with histopathology diagnostic characteristic in patient who underwent Loop Electrosurgical Excision Procedure (LEEP) was found statistically significant. Moreover, clinical application of p16 in daily practice should be performed with consideration especially for pre-cancer lesion in LEEP biopsy specimen procedure and clinicopathological approach is essential.

Background: Screening for cancer of the cervix at Kenyatta National Hospital (KNH), follows the recommended three-step strategy; Papanicolaou (Pap) smear, colposcopy/biopsy and loop electrosurgical excision procedure (LEEP)/biopsy. This approach poses the following challenges: multiple clinic visits, costly, time consuming, long turnaround time to treatment, non-compliance and loss-to-follow-up. Objective: To determine the agreement between histologies following colposcopy and LEEP amongst women in KNH as a forerunner for opportunity to shift from the three-step approach to the two-step “see and treat” (same-day colposcopy and LEEP) approach. Methods: This was a retrospective descriptive cohort of Women who underwent LEEP procedure between January 2008 and 31st December 2010 following the three-step approach at KNH, Kenya. Results: A total of 124 patients out of the 132 patients who underwent LEEP were included in the analysis. The 8 patients excluded had missing files. HIV infected, uninfected or unknown women are similar socio-demographically. The mean (SD) age for the HIV infected, uninfected and unknown is 37 (6), 33 (10) and 35 (9) years respectively. Colposcopic and LEEP biopsy histology within patients demonstrated a high weighted kappa statistics agreement of 84%. LEEP increased diagnosis of invasive cancer. Patients had a median (IQR) 5 (4 - 6) clinic visits from Pap smear to LEEP treatment. It took median (IQR) 55 (27 - 116) days between Pap smear to colposcopy result and 167 (101 - 276) days between Pap smear results to LEEP treatment. If a LEEP procedure were to be performed in this cohort of women on the same day of the colposcopy biopsy a median (IQR) 77 (55 - 137) days could have been saved. Conclusion: There is a high agreement between colposcopy and LEEP biopsies in our setting offering a window of opportunity to perform “See and Treat” same-day colposcopy and LEEP treatment procedure, skipping the colposcopy biopsy stage.

Characterizing the vaginal microbiome in patients with high grade cervical dysplasia (277)

Characteristics of a Group of Adolescents Undergoing Loop Electrical Excision Procedure (LEEP)

Our aim was to determine whether the loop electrosurgical excision procedure (LEEP) is as efficacious as cone biopsy in patients with cervical dysplasia and unsatisfactory colposcopy. Fifty-four patients with unsatisfactory coiposcopic findings underwent a LEEP procedure for the treatment of their cervical dysplasia. These patients were compared to 41 patients who had a cold-knife cone biopsy for the same indication. LEEP procedures were carried out to a standard ectocervical excision depth of 6 mm and then excised centrally to an endocervical depth of an additional 3 mm. An endocervical curettage was performed after the excision procedure. Patients were examined every 4 to 6 months after treatment with a Papanicolaou smear and colposcopy. The pretreatment cytology and cervical biopsies, histology of LEEP and cone biopsy specimens, and follow-up cytology between the two groups were compared by chisquare analysis. No statistical difference was seen in the pretreatment cervical smears between the LEEP and cone biopsy groups. All LEEP and cone biopsy specimen resection margins were negative. No difference was evident in the grade of cervical intraepithelial neoplasia between the LEEP and cone biopsy groups. Follow-up cervical smear results were similar in both groups. One patient required a cone biopsy for persistent disease 8 months after her LEEP treatment. LEEP appears to be as safe and effective as cone biopsy in patients with unsatisfactory colposcopy.

Loop electrosurgical excision procedure with or without intraoperative colposcopy: a randomized trial

Introduction Cancer of the uterine cervix is the third most common gynecologic cancer and accounts for approximately 528,000 new cancer cancers globally, on an annual basis. Cervical cancer continues to be the second leading cause of cancer death for women aged 20 to 39. Human papillomavirus (HPV) infection is responsible for the majority of cervical cancer cases. Screening with cervical cell cytology in conjunction with HPV testing is an effective screening technique that enables providers to risk-stratify women with cervical dysplasia for subsequent development of invasive cervical cancer. Colposcopy is a diagnostic technique utilized as a follow-up for abnormal cervical screening test results. Depending on the adequacy of the colposcopy procedure and the patient’s histology, an excisional procedure may be required. Loop electrosurgical excision (LEEP) is one of three common techniques employed to remove the pre- cancerous transformation zone. Theoretically this “minimally invasive” approach reduces thermal injury to surrounding structures, causes less intraoperative bleeding, and creates smaller excised specimens. The aim of this technique is to minimize cervical trauma compared to other excisional techniques. However, to date, there have been no prospective studies to examine the effect of excisional biopsy on patient-centered outcomes, such as sexual satisfaction post-procedure and subsequent development of subsequent sexual dysfunction. A 2015 review article found only 6 studies examining the effect of excisional biopsy on sexual dysfunction. There have only been four published prospective studies examining the effect of LEEP on sexual function, and only two of them utilized validated research questionnaires. Our university-based clinic performs approximately 1000 colposcopies and 100 LEEP procedures annually. The Medical Faculty Associates practice providers care to both a racially and socioeconomically diverse patient population. Objectives We plan to conduct a prospective cohort study in 736 women comparing FSFI and FSDS-R scores, and the prevalence of sexual dysfunction (defined as FSFI < 26 points) among patients who undergo colposcopy versus patients who undergo both colposcopy and LEEP. Methods The FSFI and FSDS-R questionnaires will be completed at their initial encounter after having an abnormal pap smear. This initial questionnaire will serve as our baseline measurement. If the patient did not need any additional procedures, they will complete the FSFI and FSDS-R questionnaires at 6 and 12 weeks after colposcopy. If further excision is required, patients will complete the questionnaires at 6 and at 12 weeks after their LEEP procedure. Results Results are pending completion of study enrollment. Analyses will be controlled for parity, age, menopausal status, psychotropic medication use, anxiety or depression diagnosis. Conclusions We anticipate our study to find no difference in FSFI score or FSDS-R score among women who have undergone colposcopy versus colposcopy versus LEEP. We plan to have interim results to present at the upcoming conference. Disclosure No.

The complications inherent to conization include vaginal bleeding, cervical stenosis, amenorrhea, dysmenorrhea, and deep dyspareunia. Cervical stenosis is the most important complication due to the clinical repercussions. Studies show rates of cervical stenosis ranging from 1.3 to 19% after the Loop Electrosurgical Excision Procedure (LEEP). Our primary outcome was to compare the role of a new endocervical device to prevent cervical stenosis after LEEP in patients with high-grade squamous intraepithelial lesions (HSILs). A randomized clinical trial was performed including phases II and III for evaluation of a new device for cervical stenosis prevention. In Phase II, we included 25 patients who underwent LEEP and placement of the device to assess its toxicity and efficacy. In phase III, we compared two groups (with and without the use of an anti-stenosis device) to evaluate its efficacy and safety. From August 2015 to June 2018, 265 participants were randomized (Phase II: 25, Phase III: 120 with DUDA and 120 without DUDA). The toxicity during phase II was observed in only one patient (4%) with pain grade > 7. There were 7 cases of toxicity during Phase III, 2 in the DUDA group (1.8%), and 5 in the No DUDA group (4.5%). The complications rate was numerically higher in the No DUDA group (2.5x higher) than the DUDA group, but this difference did not reach statistical significance (p = 0.52). The rate of cervical stenosis in DUDA group was (4-7,3%), and in No DUDA group was (4.3-5.8%) (p = 0.5). We did not find a significant difference when comparing the evolution at 3, 6, and 12 months in terms of cervical patency and visualization of the squamocolumnar junction (SCJ) during colposcopy. The DUDA group exhibited 15% to 19% nonvisualization of the SCJ, whereas that rate ranged from 10 to 12% in the No DUDA group. The rate of cervical stenosis was not different comparing the use of a new device, specifically produced to prevent cervical stenosis, compared to no use after LEEP procedure. This clinical trial opens up space for a discussion of the utility of using cervical stenosis devices after LEEP. Perhaps in another type of conization it can be evaluated to avoid cervical stenosis.

BackgroundThe complications inherent to conization include vaginal bleeding, cervical stenosis, amenorrhea, dysmenorrhea, and deep dyspareunia. Cervical stenosis is the most important complication due to the clinical repercussions. Studies show rates of cervical stenosis ranging from 1.3 to 19% after the Loop Electrosurgical Excision Procedure (LEEP).ObjectiveOur primary outcome was to compare the role of a new endocervical device to prevent cervical stenosis after LEEP in patients with high-grade squamous intraepithelial lesions (HSILs).MethodsA randomized clinical trial was performed including phases II and III for evaluation of a new device for cervical stenosis prevention. In Phase II, we included 25 patients who underwent LEEP and placement of the device to assess its toxicity and efficacy. In phase III, we compared two groups (with and without the use of an anti-stenosis device) to evaluate its efficacy and safety.ResultsFrom August 2015 to June 2018, 265 participants were randomized (Phase II: 25, Phase III: 120 with DUDA and 120 without DUDA). The toxicity during phase II was observed in only one patient (4%) with pain grade > 7. There were 7 cases of toxicity during Phase III, 2 in the DUDA group (1.8%), and 5 in the No DUDA group (4.5%). The complications rate was numerically higher in the No DUDA group (2.5x higher) than the DUDA group, but this difference did not reach statistical significance (p = 0.52). The rate of cervical stenosis in DUDA group was (4–7,3%), and in No DUDA group was (4.3–5.8%) (p = 0.5). We did not find a significant difference when comparing the evolution at 3, 6, and 12 months in terms of cervical patency and visualization of the squamocolumnar junction (SCJ) during colposcopy. The DUDA group exhibited 15% to 19% nonvisualization of the SCJ, whereas that rate ranged from 10 to 12% in the No DUDA group.ConclusionsThe rate of cervical stenosis was not different comparing the use of a new device, specifically produced to prevent cervical stenosis, compared to no use after LEEP procedure. This clinical trial opens up space for a discussion of the utility of using cervical stenosis devices after LEEP. Perhaps in another type of conization it can be evaluated to avoid cervical stenosis.

Pregnancy outcome after loop electrosurgical excision procedure for cervical intraepithelial neoplasia

To examine rates and predictors of compliance with follow-up recommendations in low-income women from a county hospital clinic undergoing loop electrosurgical excision procedure (LEEP) and cone knife cone biopsy. A retrospective cohort study of 135 patients who underwent LEEP or cold knife cone biopsy was performed. Demographic data, results of cytology, colposcopy biopsy, excision specimen pathology, and indication for the LEEP or cold knife cone biopsy were collected. Compliance was determined by whether the patient adhered to the recommended follow-up within 1 year from the date of the procedure. Multivariable analysis was performed by using logistic regression. A total of 135 patients were included for analysis (81 LEEP and 54 cold knife cone cases). Type of procedure was significant in predicting compliance: 74.1% of cold knife cone patients were compliant compared with 43.2% of LEEP patients (adjusted relative risk 1.64, 95% confidence interval 1.30-1.87). There was a trend for older patients to be more compliant than younger patients in the univariable analyses but not in multivariable analysis. After adjusting for age, LEEP patients were still significantly less compliant than cold knife cone patients. Pathologic indication (severity of disease), race, payor source, and gravidity were not significant predictors of compliance and not included in the multivariable analysis. Compared with LEEP, cold knife cone patients were significantly more compliant with follow-up. Because LEEP is a less invasive in-office procedure, it may convey to patients the idea that their condition is less severe. II.

Active surveillance of cervical intraepithelial neoplasia grade 2 is not associated with an increased risk of noncervical anogenital human papillomavirus-related cancer and precancer: a population-based cohort study.

The objective of this study was to evaluate the treatment outcomes and complications in human immunodeficiency virus (HIV)-infected women undergoing loop electrosurgical excision procedure (LEEP) for cervical neoplasia. The medical record of 60 evaluable HIV-infected women who had abnormal Papanicolaou (Pap) smear and underwent LEEP following colposcopy at Chiang Mai University Hospital between May 1998 and June 2004 was reviewed. Thirty-one (51.7%) had associated genital infection at screening. Twenty-five (41.7%) had opportunistic infection, but only 18 (30.0%) were treated with antiretroviral therapy. The most common abnormal Pap smear was high-grade squamous intraepithelial lesion (46.7%), followed by low-grade squamous intraepithelial lesion (40.0%). Forty (66.7%) women had clear surgical margins after LEEP. Only one (1.7%) woman had severe intraoperative hemorrhage. Early and late postoperative hemorrhage were noted in three (5%) women of each period. Localized infection of the cervix was detected in seven (11.7%) women. Two (3.3%) women developed cervical stenosis at 6 months after LEEP. There was no significant difference in overall complications between HIV-infected women and the control group (P= 0.24). Among 60 HIV-infected women, no statistical difference in the rate of margins involvement (P= 1.00) and complications (P= 0.85) could be demonstrated between HIV-infected women who received antiretroviral therapy and those who did not. Disease-free rate at 6 and 12 months were 97.1% and 88%, respectively. These data demonstrated that LEEP appears to be safe and effective in HIV-infected women.

Outcomes of loop electrosurgical excision procedure for cervical neoplasia in human immunodeficiency virus–infected women

Cervical cancer has become a global problem with high mortality and morbidity and contributed to around 311,000 deaths in 2018 which tends to rise every year. Detection of cervical cancer is very necessary to provide appropriate management to patients. Various detection and diagnosis approaches to cervical cancer continue to be developed along with advances in technology. However, comparisons of the types of methods used have not been widely reported. A biopsy is a tool used to detect a suspected malignancy that has been used for many years. One of them is a punch biopsy, a method often used to detect cervical cancer. Currently, technology is developed with the discovery of various other diagnostic tools such as Loop Electrosurgical Excision Procedure (LEEP). LEEP is an excisional procedure in high-resource settings to provide tissue for histopathology. However, the role of punch biopsy can’t be ruled out. This article discusses the differences between a punch biopsy and a LEEP procedure and the advantages and disadvantages of both.