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Gynecology (Expert Forum)
LEEP Results
Answered by
Elaine Brown, MD - Pregnancy, Gynecology
Elaine Brown, MD - BLOG
Billings - MT
LEEP Results
by tracievh, Oct 18, 2009 01:36PM
I posted several weeks ago about my situation and have an update/question.
Recap:
2005 abnormal pap; mild dysplaisa – no treatement
2009 of Sept. abnormal pap with atypical squamous and atypical glandular cells.
Had a LEEP done Oct 1st.
Path. Report:
Foci of high grade squamous intraepithelial lesion ( severe squamous dysplasia, CIN 3 ). One focus of HGSIL is present at an inked and cauterized endocervical margin and stains positively with P16 and shows a marked increase in proliferative activity on KI-67 stains. This represents a positive margin.
Based on those results my onc/gyn suggested three possible treatments:
an endocervical excision with ecc ( done like the LEEP procedure)
A cold knife cone
Or hysterectomy
Even though I am 38 and have no plans to have children ( tubal ligation done in 1990) I think that I will go with the cold knife cone. Do you think this is a wise choice?
Also, what are the chances it will come back?
Is it possible that these results may show something more severe like AIS? ( still can’t get my mind off those atypical glandular cells! )
Thanks in advance
Recap:
2005 abnormal pap; mild dysplaisa – no treatement
2009 of Sept. abnormal pap with atypical squamous and atypical glandular cells.
Had a LEEP done Oct 1st.
Path. Report:
Foci of high grade squamous intraepithelial lesion ( severe squamous dysplasia, CIN 3 ). One focus of HGSIL is present at an inked and cauterized endocervical margin and stains positively with P16 and shows a marked increase in proliferative activity on KI-67 stains. This represents a positive margin.
Based on those results my onc/gyn suggested three possible treatments:
an endocervical excision with ecc ( done like the LEEP procedure)
A cold knife cone
Or hysterectomy
Even though I am 38 and have no plans to have children ( tubal ligation done in 1990) I think that I will go with the cold knife cone. Do you think this is a wise choice?
Also, what are the chances it will come back?
Is it possible that these results may show something more severe like AIS? ( still can’t get my mind off those atypical glandular cells! )
Thanks in advance
Doctor's Answer
by Elaine Brown, MD, Oct 21, 2009 10:54AM
, Oct 21, 2009 10:54AMTo: tracievh
Hi!
If I were in your situation, I think I would go with the cone biopsy. If you knew for sure that you wanted children, I would go with the ECC/ etc. If you knew 100% that you would never want children, the hysterectomy might sound good. If you want the best diagnostic procedure that leaves your options open ( 38 is young!) the cone is the way to go. Yes, it IS possible that the specimen will show something more than CIN 3. The MOST likely finding will be a negative sample. I'll bet that either they don't find any more dysplasia, or if they do, that they find CIN 3. But, that is the reason to do the cone-which by the way is a satisfactory treatment for AIS.
Since dysplasia is caused by HPV which is currently not curable, it is always possible for the abnormal cells to come back. We always hope that by removing all of the transformation zone and abnormal cells within it, that we permanently solve the problem, but you will need to keep up your careful surveillance!
Good luck!
Dr B
If I were in your situation, I think I would go with the cone biopsy. If you knew for sure that you wanted children, I would go with the ECC/ etc. If you knew 100% that you would never want children, the hysterectomy might sound good. If you want the best diagnostic procedure that leaves your options open ( 38 is young!) the cone is the way to go. Yes, it IS possible that the specimen will show something more than CIN 3. The MOST likely finding will be a negative sample. I'll bet that either they don't find any more dysplasia, or if they do, that they find CIN 3. But, that is the reason to do the cone-which by the way is a satisfactory treatment for AIS.
Since dysplasia is caused by HPV which is currently not curable, it is always possible for the abnormal cells to come back. We always hope that by removing all of the transformation zone and abnormal cells within it, that we permanently solve the problem, but you will need to keep up your careful surveillance!
Good luck!
Dr B
This is what eventually lead to the LEEP.