[Histonet] Re: Microtomy of LEEP specimens

[Robert Richmond]

Joanne Clark, HT, MLT, at Pathology Consultants of New Mexico, Roswell NM asks:

>>How many of you have a protocol to cut multiple deepers/levels on LEEP specimens and if so, how many do you cut?<<

LEEP (Loop Electrosurgical Excision Procedure) excises the
transformation zone of the cervix (the level where the columnar
epithelium of the endocervix suddenly becomes the squamous epithelium
of the exocervix), excising dysplastic epithelium that can turn into
invasive cervical cancer.

The pathologist needs to answer two questions: is dysplastic
epithelium present, and does it extend to the margins of the specimen?

LEEP specimens are often inked when they're grossed, but inking isn't
worth doing - the cautery artifact defines the margins. They've
lowered the cautery (the hot wire) voltage since the procedure was
introduced around 20 years ago, but the specimens are still often Post
Toasties.

The stakes aren't very high on these specimens. Dysplasias recur at
about the same rate whether the margins are positive or negative.

Two or three slides per block is adequate, with some trimming between
the sections. I rarely order further deeper cuts.

Bob Richmond
Samurai Pathologist
Knoxville TN