The Overtreatment Risk of See-and-Treat Strategy in Management of Abnormal Cervical Cytology

Abstract

Background: To evaluate the feasibility of conization without a prior punch biopsy for patients with abnormal cytology. Methods: A retrospective review was performed for 700 patients who underwent conization at a single institution from January 2003 to August 2012. Each of these patients was assigned to one of two groups, either the ‘see-and-treat' group or the ‘three-step' group, depending on whether the patient had undergone a punch biopsy before conization or not. The final histologic results of two groups were compared. Results: The overtreatment risk was higher in the ‘see-and-treat' group in patients with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASCUS/LSIL) cytology (64.7% in the ‘see-and-treat' group vs. 36.5% in the ‘three-step' group; p = 0.001). There was no significant statistical difference in the rate of cervical dysplasia or invasive carcinoma in patients with high-grade squamous intraepithelial lesion (HSIL) cytology between groups (91.8% in the ‘see-and-treat' group vs. 93.5% in the ‘three-step' group; p = 0.793). Conclusion: The patients with HSIL on cytology can be managed by a ‘see-and-treat' strategy with a low risk of overtreatment. On the other hand, the ‘three-step' management is more appropriate in patients with ASCUS/LSIL cytology.

See and treat strategy by LEEP conization in patients with abnormal cervical cytology

“…For example, Bosgraaf et al [20] demonstrated that women aged 40 years or more are more likely to be over-treated. Additionally, Kim YJ et al [21] found that ASCUS and LSIL cytology are associated with higher rates of overtreatment in patients who undergo S & T. In our study, overtreatment was seen in only 6% of patients with glandular involvement. Also, in the advanced age group, overtreatment was much higher compared to the other group (< 45 years of age) in the study.…”

Role of Colposcopy in Evaluation of Abnormal Cytology a Tertiary Care Centre Experience

“…Other authors have also reported increase in cytopathological abnormalities with increasing age and parity. [13][14][15][16] The mean age at first intercourse in our study was 20.94 years which was higher as compared to other studies who reported an association between early age at first intercourse and increased risk of cervical cancer. 14,17 Majority of the patients in our study (86.9%) were Hindu and 11.9 % were Muslims which is consistent with 2011 Census data where 79.8% Indian population practices Hinduism and 14.2% Islam.…”

Overtreatment in the see-and-treat approach for high-grade squamous cervical cytology

“…In 2015, Ebisch et al published a meta-analysis which reported an overtreatment rate of 11.6% for the ‘see-and-treat’ approach for women presenting with HSIL cervical cytology with colposcopic impression indicating a high-grade lesion [8] . Later studies reported overtreatment rates of 3.2–20% [9] , [10] , [11] , [12] , [13] , [14] . A study of factors influencing overtreatment with the ‘see-and-treat’ approach is still needed.…”