622 Arch Pathol Lab Med—Vol 131, April 2007 Margin of Cervical LEEP Biopsy—Tyler et al Significance of Margin and Extent of Dysplasia in Loop Electrosurgery Excision Procedure Biopsies Performed for High-Grade Squamous Intraepithelial Lesion in Predicting Persistent Disease Lisa N.Tyler, MD; Nancy Andrews, MD; Rudolph S. Parrish, PhD; Linda J. Hazlett, MPH; Soheila Korourian, MD ● Context.—High-grade squamous intraepithelial lesions (cervical intraepithelial neoplasia 2 and 3) are commonly treated with loop electrosurgery excision procedure (LEEP) biopsies. Objective.—To highlight the significance of positive margins and extent of positive margins of the cervical LEEP biopsies in predicting the persistence of high-grade squa- mous intraepithelial lesion and to provide suggestions for reporting margins in cervical LEEP biopsies. Design.—The pathology files at the University of Arkan- sas for Medical Sciences were searched for cervical intra- epithelial neoplasia 2 and 3 treated by LEEP biopsy from 1990 to 2001. Results.—A total of 489 LEEP biopsy specimens were re- trieved and reviewed; 270 patients had follow-up within 1 year.The biopsy specimens of 110 patients showed positive endocervical margins. One hundred sixty specimens had negative ectocervical-endocervical margins. Follow-up of 54% of the cases with initial positive margins showed re- sidual high-grade squamous intraepithelial lesions. This as- sociation was even greater when multiple blocks showed positive endocervical margins and in cases with positive deep margins. On the other hand, a negative margin pre- dicted ability to completely remove the lesion in 95% of patients. Conclusion.—This study reiterates the significance of the evaluation of the margin, even in samples that were re- ceived as multiple fragments. Reporting of LEEP biopsy findings should include the extent of the dysplasia, the sta- tus of the ectocervical-endocervical margin, and the status of the deep margin. (Arch Pathol Lab Med. 2007;131:622–624) A cervical biopsy specimen obtained by loop electrosur- gery excision procedure (LEEP) is used to diagnose and treat high-grade squamous intraepithelial lesions (HSILs) (cervical intraepithelial neoplasia [CIN] 2 and 3). 1,2 LEEP is a safe method for treating HSILs. 3,4 LEEP biopsy was introduced in 1989 by Prendiville et al 5 to treat cervical dysplastic lesions that could be completely visu- alized at the time of colposcopy. During recent years, in- dications have extended beyond cases that involved the ectocervix to include lesions with margins not defined at colposcopy. Cervical LEEP biopsies are also used for the diagnosis and possible treatment of cases in which abnor- mal Papanicolaou smears show CIN 2 and 3 that could not be visualized at the time of colposcopy. 6–8 The major advantages of LEEP over cold-knife coniza- tion are a shorter operation time, less blood loss, and fewer Accepted for publication August 15, 2006. From the Departments of Pathology (Drs Tyler and Korourian), Ob- stetrics and Gynecology (Dr Andrews), and Biostatistics (Dr Parrish), University of Arkansas for Medical Sciences, Little Rock; and the De- partment of Epidemiology and Biostatistics, University of South Caro- lina, Columbia (Dr Hazlett). The authors have no relevant financial interest in the products or companies described in this article. Reprints: Soheila Korourian, MD, Department of Pathology, Slot #517, University of Arkansas for Medical Sciences, 4301 W Markham, Little Rock, AR 72205 (e-mail: Korouriansoheila@uams.edu). long-term complications. 1,3,5 The importance of positive margins and the presence of residual disease have been reviewed in the past. 9–12 We investigated the significance of positive margins and the extent of dysplasia at the en- docervical or ectocervical margins and the deep margin of the LEEP biopsy specimens in predicting the presence of residual disease. MATERIALS AND METHODS The pathology files at the University of Arkansas for Medical Sciences, Little Rock, were searched for cases of CIN 2 and 3 that were treated by LEEP biopsy from 1990 to 2001. We identified 489 patients with HSIL whose lesions were diagnosed or treated by cervical LEEP biopsy. A total of 201 patients were lost to fol- low-up; 96 (48%) of them had positive endocervical margins, and 105 (52%) had negative endocervical margins. The final sample size was 270; patients with follow-up longer than 1 year (n = 18) were excluded from the study. Gross descriptions of 50 cases seen from July 1997 to 2001 were available for review. Because of a change in the computer program used in the department, we did not have access to the gross description of the remaining cases. Thirty-one of these cases (62%) were received as 2 or more frag- ments; 19 (38%) of these specimens were a single fragment. Al- though this represents a fraction of the study material, it can be assumed that these are representative of all cases. We reviewed the original surgical pathology reports available in the computer system, the follow-up reports, and glass slides. Ectocervical-en- docervical margins and deep margins were reevaluated. A margin was considered positive if HSIL was present at the