Gross Examination of Cervical Tissue Obtained via the LEEP Procedure

Abstract

Loop Electrosurgical Excision Procedure (LEEP) is the standard procedure in the treatment of HPV-related
cervical lesions. The excised cervical tissue sample should be submitted for histopathological examination post-
operatively for assessing involvement and margins of the disease. Samples can be collected as fresh or formalin-fixed specimen. This article offers outlines an approach and strategy for the gross examination of both types of specimens. There are clear advantages to the use of fresh material, including the ability to flatten and optimally orient the tissue prior to fixation which in turn facilitates more complete and accurate sectioning of the transformation zone. However, this procedure is associated with the potential risk of cellular autolysis due to the delayed processing. Formalin-fixed specimens on the other hand are preserved and resistant to cellular degradation and can be stored for years. The chief disadvantage is that the fixed cone-shaped specimen becomes stiff and it is difficult to completely flatten the tissue to properly section the transformation zone. Here, we provide a full description of the handling of fresh and fixed surgical specimens and a discussion focused on advantages and limitations. These data provide a framework for laboratories to choose the optimal method for specimen handling under their individual circumstances and available resources.