“See and Treat” Electrosurgical Loop Excision of the Cervical Transformation Zone

Ferris, D G; Hainer, Barry L.; Pfenninger, John L.; Zuber, Thomas J.

doi:10.1097/00128360-199704000-00021

Cited by 22 publications

(39 citation statements)

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“…However, one of its disadvantages is potential unnecessary treatments as claimed by other authors. 1,2,3,5,11 The traditional approach with a targeted biopsy for diagnostic confirmation requires more medical visits before the actual treatment of the lesions. 11 This causes increased anxiety to patients, which can in turn lead to dropout before treatment.…”

Section: Resultsmentioning

confidence: 99%

Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

et al. 2009

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Efetividade da abordagem "ver e tratar" em lesões pré-invasivas no colo uterino ABSTRACT OBJECTIVE: To compare the effectiveness between the see-and-treat (S&T) approach and the conventional one (with prior biopsy) for squamous intraepithelial lesions of uterine cervix. METhODS:A cross-sectional study was conducted with 900 nonpregnant women with cytology suggestive of high grade squamous intraepithelial lesions in the city of Rio de Janeiro, Southeastern Brazil, between 1998 and 2004. The S&T approach consists of a large loop excision of the transformation zone procedure and is recommended when cytology is suggestive of high grade squamous intraepithelial lesion, satisfactory colposcopy with abnormalities compatible with the suspected cytological results, and the lesion is limited to the ectocervix or extends up to one centimeter of the endocervical canal. A subgroup of 336 patients whose colposcopy was considered satisfactory was analyzed, and they were divided into two groups for comparison: patients treated without prior biopsy (n = 288) and patients treated after a biopsy showing high grade squamous intraepithelial lesions (n = 48). Patients who were not treated or only treated more than a year later after recruitment at the colposcopy unit were considered dropouts. RESULTS:Of patients recruited during the study period, 71 were not treated or were only treated for at least a year. The overall dropout rate was 7.9% (95% CI: 6.1;9.7). Mean time elapsed between patient recruitment and treatment was 17.5 days in the S&T group and 102.5 days in the prior biopsy group. Dropout rates were 1.4% (95% CI: 0.04;2.7) and 5.% (95% CI: 0;12.3), respectively (p=0.07). The proportion of overtreated cases (negative histology) in the S&T group was 2.0% (95% CI: 0.4;3.6). CONCLUSIONS:The difference in the mean time elapsed between patient recruitment and treatment indicates that S&T is a time-saving approach The proportion of negative cases from using the S&T approach can be regarded as low. The "see-and-treat" (S&T) approach for high-grade intraepithelial squamous lesions (HSIL) of uterine cervix consists of performing both diagnosis and treatment in one single visit. In Brazil, this approach was launched in 1997 as part of the National Program a for Uterine Cancer Management, Viva Mulher, to treat pre-invasive cervical lesions. The S&T approach included a large loop excision of the transformation zone (LLETZ) 9 procedure and is recommended when cytology is suggestive of HSIL (or cervical intraepithelial neoplasia grades 2 or 3 -CIN 2/3), satisfactory colposcopy (transformation zone completely visible) with abnormalities compatible with the suspected cytological results, and the lesion is limited to the ectocervix or extends up to one centimeter of the endocervical RESUMO OBJETIVO: Comparar a efetividade do método "ver-e-tratar" (V&T) com a abordagem tradicional (biópsia prévia) das lesões escamosas intraepiteliais do colo uterino. DESCRIPTORS:MéTODOS: Trata-se de um estudo transversal realizado na cidade do Rio de Janeiro, ...

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Section: Resultsmentioning

confidence: 99%

Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

et al. 2009

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“…20 Smokers are less likely to clear HPV infection and have an increased risk for cervical neoplasia. 21,22 Interesting correlates of vaccine acceptance were also seen when men's sexual history was examined. Men who were not currently sexually active were more likely to want the HPV vaccine.…”

Section: Discussionmentioning

confidence: 99%

Variables Associated With Human Papillomavirus (HPV) Vaccine Acceptance by Men

Ferris

Waller²,

Miller

et al. 2009

The Journal of the American Board of Family Medicine

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Objective: To determine correlates of human papillomavirus (HPV) vaccine acceptance for men.Methods: A convenience sample of men aged 18 to 45 years read a one-page information sheet about HPV and the HPV vaccine, then completed a 29-item questionnaire.2 tests were used to determine whether differences in demographic, sexual, and vaccine-related variables existed between levels of wanting the HPV vaccine.Results: Positive correlates of HPV vaccine acceptance included higher education (P < .0001); hispanic ethnicity (P ‫؍‬ .0003); wearing a seat belt most of the time (P ‫؍‬ .02); regular tobacco use (P ‫؍‬ <.001); not being sexually active (P ‫؍‬ .0008); history of more than 10 female sexual partners (P ‫؍‬ .0004); not having oral sex (P ‫؍‬ .045); extreme worry about vaccine side effects (P < .0001); extreme concern about vaccine safety (P < .0001); the importance of getting vaccines (P < .0001); familiarity with HPV (P < .0001); and extreme importance of receiving the HPV vaccine (P < .0001).Conclusions In 2006, the US Food and Drug Administration (FDA) approved the quadrivalent human papillomavirus (HPV, types 6/11/16 and 18) L1 virus-like particle vaccine. This prophylactic vaccine prevents cervical, vaginal, vulvar, and perianal neoplasias, including anogenital condylomata.1-4 Based on epidemiologic data, the vaccine should reduce the incidence of cervical cancer by 70% and genital warts by 90%. Universal protection is afforded when administered to people not previously exposed to the HPV types covered by the vaccine. Currently, the vaccine is approved for use in 9-to 26-year-old girls and women.Many low-risk and high-risk types of HPV can also infect various anatomic sites in boys and men. 5The low-risk types of HPV cause recurrent respiratory papillomatosis or condylomata of the nasopharynx. 6,7 Anogenital warts are also caused by low-risk HPV types 6 and 11. High-risk HPV types cause precancers and cancer of the penis and anus.8 -13 HPV 16, a particularly virulent type, causes head and neck cancer.14,15 Just as with women, men experience significant morbidity and potential mortality from HPV-related diseases.Women clearly benefit from receiving the HPV vaccine. One would assume men could also benefit by being vaccinated against low-and high-risk HPV types. Correlates of HPV vaccine acceptance have been identified for mid-adult women.16 However, correlates of HPV vaccine acceptance among men have not been described. The purpose of these analyses were to determine correlates of HPV vaccine acceptance among men. Methods PopulationA convenience sample of 18-to 45-year-old men were recruited to participate in our study. Subjects were enrolled at various places in Augusta and Atlanta, Georgia, including a local military base, college campuses, fire stations, a university-based family medicine center waiting room, and from elsewhere in the community. Inclusion criteria included an interest to complete a brief questionnaire; being a man; 18-to 45-years-old; and an This article was externally peer reviewed.

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“…2 In 1995 they reported a 15.4% rate of positive margins (26 of 169 LEEP specimens) when treating all grades of dysplasia. Are our results acceptable?…”

Section: Discussionmentioning

confidence: 99%

“…2 The primary inclusion criterion for this study was cervical dysplasia of any severity. One hundred thirty-two of 198 patients had at least one Papanicolaou smear and a repeated colposcopy after LEEP.…”

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confidence: 99%

LEEP in the Family Practice Setting

Lyman

Morris²

2003

The Journal of the American Board of Family Medicine

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Background: 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.Methods: 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.Results: 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).

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“See and Treat” Electrosurgical Loop Excision of the Cervical Transformation Zone

Cited by 22 publications

References 0 publications

Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix

Variables Associated With Human Papillomavirus (HPV) Vaccine Acceptance by Men

LEEP in the Family Practice Setting

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