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Comparison of Two Step LEEP and Cold Conisation For Cervical Intraepithelial Lesions to Decrease Positive Surgical

Taylan Senol¹, Mesut Polat, Enis Ozkaya

¹Zeynep Kamil Training and Research Hospital, Obstetric and Gynecology Department, Istanbul, Turkey

Asian Pacific Journal of Cancer Prevention : APJCP

|August 12, 2016

Summary

The two-step loop electrosurgical excision procedure (LEEP) is more effective than cold conization for achieving negative endocervical margins in patients with high-grade cervical intraepithelial neoplasia (CIN). This minimally invasive technique offers reduced blood loss and office-based applicability.

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Published on: September 12, 2025

Area of Science:

Gynecology
Oncology
Surgical Procedures

Background:

Cervical intraepithelial neoplasia (CIN) 2/3 or persistent CIN 1 requires treatment to prevent progression to cervical cancer.
Loop electrosurgical excision procedure (LEEP) and cold conization are common methods for treating CIN.
Assessing the efficacy of different surgical techniques in achieving clear margins is crucial for patient outcomes.

Purpose of the Study:

To compare the success rates of two-step loop electrosurgical excision procedure (LEEP) versus conventional cold conization in reducing positive surgical margins.
To evaluate the effectiveness of two-step LEEP in cases of high-grade and glandular CIN.

Main Methods:

A comparative study involving 70 patients with CIN 2/3 or persistent CIN 1.
Patients were divided into two age-matched groups: cold conization (n=40) and two-step LEEP (n=30).
Surgical margin status, tissue depth, and volume were analyzed.

Main Results:

Two-step LEEP resulted in significantly greater depth of excision and lower tissue volume removed compared to cold conization.
Endocervical surgical margin positivity was significantly lower in the two-step LEEP group (0/29) than in the cold conization group (9/39).
Ectocervical positivity rates were similar between the groups.

Conclusions:

Two-step LEEP facilitates access to the endocervical region's squamocolumnar junction.
This technique offers benefits such as reduced blood loss and suitability for office settings.
The two-step LEEP approach is recommended for patients with high-grade and glandular CIN.