LEEP in the family practice setting

We wanted to review our 7-year experience using the loop electrical excision procedure (LEEP) for the treatment of cervical dysplasia in a family practice residency setting in the rural South.

We conducted a retrospective study with data gathered from chart review of a mostly Medicaid and uninsured patient population of rural Southern women referred from outlying health departments or private practices within an 80-mile radius. The women received follow-up Papanicolaou smears, and outcome measurements were either recurrence of dysplasia or at least 1 year with two negative Papanicolaou smears. Any surgical tissue obtained after LEEP was used to ascertain residual or recurrent dysplasia.

Rates of disease recurrence and incomplete excision of cervical intraepithelial neoplasia grade 2/3 (CIN 2/3) compared favorably with results published by expert US gynecologists but were worse than those reported by European authors, who excise all CIN (CIN 1, CIN 2, and CIN 3).

CIN 2 and CIN 3 can be diagnosed and treated appropriately with LEEP in the setting of a family practice residency.