The Loop Electrosurgical Excision Procedure, or LEEP, is a common outpatient procedure used to manage abnormal cells on the cervix. This technique utilizes a thin wire loop heated by an electric current to remove a cone-shaped piece of tissue from the cervix. The primary goal of the LEEP is to prevent the development of cervical cancer by excising the potentially precancerous tissue. This process is highly effective and is a standard treatment option for women with specific abnormal cell changes.
Medical Indications for the Procedure
The LEEP procedure is recommended when a patient is diagnosed with high-grade changes to the cervical cells. These changes are medically termed high-grade squamous intraepithelial lesions (HSIL) or Cervical Intraepithelial Neoplasia (CIN) grades 2 or 3. Without intervention, these high-grade lesions carry a substantial risk of progressing into invasive cervical cancer over time.
The procedure serves a dual purpose as both a diagnostic and therapeutic tool. Therapeutically, the heated wire loop excises the entire abnormal area, effectively eliminating the disease. Diagnostically, the removed cone of tissue is sent to a lab for pathological examination. This analysis confirms the severity of the abnormality and verifies that the excision successfully removed all the diseased tissue.
Immediate Success Rates
The immediate success of the LEEP procedure is measured by the clearance of the abnormal cells, defined by achieving “negative margins.” Negative margins mean that the pathologist’s examination of the excised tissue shows no abnormal cells at the edges of the removed cone. This finding indicates that the entire lesion was successfully taken out.
The procedure is highly effective, with reported cure rates for cervical intraepithelial neoplasia (CIN) often falling in the range of 73% to 99%. For high-grade lesions, the success rate for complete removal and subsequent prevention of cervical cancer is cited at 90% or higher. This high rate of success is why LEEP is considered a standard and reliable treatment for preventing the progression to cancer.
Long-Term Monitoring and Recurrence Risk
Long-term effectiveness of the LEEP is judged by the sustained absence of the precancerous cells. While initial success rates are high, there remains a small chance of recurrence, meaning that abnormal cells could return later. The recurrence rate for precancerous lesions ranges between 5% and 30%, with some studies reporting a low rate of approximately 4% within five years of the procedure.
Because of this risk, post-procedure surveillance is a required part of the treatment protocol. The recommended follow-up schedule involves regular testing, starting six months after the LEEP. This surveillance includes both a Pap test and an HPV test, performed every six to twelve months for a period of up to two years. If these follow-up tests remain consistently negative, the patient can then return to a less intensive, routine screening schedule.
Factors Determining Effectiveness
The ultimate success of the LEEP procedure is influenced by several specific patient and procedural factors. The most significant factor is the status of the margins on the excised tissue. If the margins are positive, meaning abnormal cells were found at the edges, the risk of residual disease and subsequent recurrence is higher.
The patient’s status regarding high-risk human papillomavirus (HPV) infection after the procedure also strongly predicts long-term outcomes. HPV is the underlying cause of nearly all cervical cell abnormalities. If the high-risk HPV infection persists after the LEEP, the chance of recurrence is significantly elevated. For instance, the recurrence rate for CIN is very low when margins are negative and there is no residual HPV, but it increases if HPV is still present. Other elements, such as the size and depth of the initial lesion and the patient’s age (those over 40 may have a higher risk), can also play a role in determining the overall effectiveness of the treatment.