Postprocedural Pap Smears: a LEEP of faith?

Area of Science:

• Gynecologic Pathology
• Cervical Cytology
• Surgical Pathology

Background:

• Loop electrosurgical excision procedure (LEEP) is a common outpatient treatment for cervical intraepithelial neoplasia (CIN).
• Cytologic evaluation of post-LEEP samples is not routine but can reveal procedure-specific artifacts.
• Accurate interpretation of these cytologic changes is essential for patient management.

Purpose of the Study:

• To describe the cytomorphologic features observed in immediate post-LEEP endocervical brush (PLEB) samples.
• To highlight common diagnostic challenges and artifacts associated with LEEP cytology.
• To emphasize the importance of recognizing these features for accurate interpretation.

Main Methods:

• Review of immediate post-LEEP endocervical brush (PLEB) samples.
• Identification and documentation of characteristic cytomorphologic features.
• Analysis of diagnostic dilemmas encountered in interpreting PLEB smears.

Main Results:

• Common findings include "taffy-pulled" nuclei, coalesced cytoplasm, "hockey stick" nuclei, notched/enlarged nuclei, and smudgy chromatin.
• Abundant blood and smudgy chromatin can mimic an "unsatisfactory" sample.
• These changes are procedure-related and reproducible.

Conclusions:

• Familiarity with LEEP-associated cytomorphologic changes improves the accuracy of PLEB sample interpretation.
• Recognizing thermal artifacts is key to distinguishing them from neoplastic changes.
• The clinical significance of abnormal PLEB findings for disease clearance remains under investigation.