Cervix (LEEP or Cone)

Auto text: “Insert Leep Cone”


Cervical cone biopsies and LEEPs (loop electrosurgical excision procedure) are both performed to remove pre-cancerous lesions from the cervix.

Cervical cone biopsies are performed with either a laser or surgical blade (cold knife) and result in a conical excision of cervical tissue centered on the os.  These specimens are usually received fresh from the OR, are oriented, and require triage prior to fixation.

LEEP specimens vary in size and shape depending on the size/shape of the loop used.  LEEPs are generally received from the clinics in formalin, are usually not oriented, and do not require triage prior to grossing.  At receipt, LEEP specimens can be intact or fragmented.  They can be received in multiple containers (eg. “anterior lip”, “posterior lip”) and submitted with an ECC specimen.  Additionally, there is sometimes a specimen submitted labeled “top hat” which is the last pass made with the loop and represents the definitive endocervical margin.  Due to the variation in LEEP specimens, please make sure that you review with a PA or senior resident the first few times you see these specimens to make sure that you can properly orient them prior to inking/sectioning.

Triage/Gross of Cervical Cone

  1. Ideally these will be submitted intact, with a suture to indicate the orientation, usually the 12 o’clock position.  Measure the transverse diameter at the ectocervix, describe and measure the os, and measure the height of the cone.
  2. Ink the ectocervical/radial margin one color.  If the specimen is received open or fragmented (not uncommon), ink the non-mucosal surfaces.
  3. Ink the endocervical margin a second color.
  4. For intact cones, open at 12:00 in the plane of the endocervical canal. Pin the cone flat, mucosa up, and fix in formalin for at least 2-3 hours prior to sectioning.
  5. For oriented specimens: thinly section radially (ideally 2 mm sections), ensuring each section has endocervical and ectocervical margins. Serially submit in a clockwise direction, NO MORE than 2 sections per cassette.
  6. For non-oriented/fragmented specimens: radially section, and submit 2-3 pieces per cassette.
  7. If small tissue fragments and/or mucoid material is left in the specimen container, filter and submit this in a mesh bag.

Updated 5/6/24 SRR

Print Friendly, PDF & Email