Predictors of Suboptimal Loop Electrosurgical Excisional Procedure [1Q]

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Abstract

INTRODUCTION:

Cervical intraepithelial neoplasia (CIN) is a well established precursor lesion for squamous cell carcinoma of the cervix. Loop electrosurgical excisional procedure (LEEP) is the most popular method for treating cervical dysplasia. Our objective was to determine predictors of suboptimal LEEPs defined as endocervical margin involvement or 3 or more specimen fragments.

METHODS:

Study approval was obtained from the University of Oklahoma School of Community Medicine Institutional Review Board committee. A retrospective review of patients undergoing office-based LEEP at a single institution between January 2012 and December 2014 was performed. Patients were identified in a billing database by CPT codes for colposcopy with loop. Medical records were reviewed to identify patient demographics, cervical cytology results and histology, margin status, and number of fragments in the LEEP specimen. Data analysis was performed using SPSS and Epi info. Categorical values were compared using Fisher Exact and continuous variables by T test.

RESULTS:

A total of 73 women were identified and underwent statistical analysis. Mean age at time of LEEP was 32.8±9.8. Mean body mass index was 29.8±7.5 (18.7–54.0). Patients with larger BMIs were more likely to have 3 or more specimen fragments (33.1 vs 28.6); P=.03). BMI was unrelated to margin status.

CONCLUSION:

Quality of LEEP specimen is affected by body mass index. Obese women are more likely to have fragmented specimens but not positive endocervical margins. Obese women may be better candidates for LEEP performed under anesthesia. Further research evaluating LEEPs in obese women needs to be performed.

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