The “see and treat” strategy for identifying cytologic high‐grade precancerous cervical lesions among low‐income Brazilian women

Nogara, Paula Regina Bach; Manfroni, L. A. R.; Silva, Mariana C. da; Consolaro, Márcia Edilaine Lopes

doi:10.1016/j.ijgo.2012.02.017

Cited by 10 publications

(13 citation statements)

References 15 publications

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“…This result is comparable to findings from previous studies, which have reported 61-74% high-grade dysplasia among patients with HSIL cytology [4,10,19]. In this study, the rate of invasive cancer in patients with HSIL cytology was extraordinarily high.…”

Section: Discussionsupporting

confidence: 90%

“…Unlike invasive SCC, precancerous lesions of the uterine cervix are more frequently found in patients before the age of 40. Therefore, the decision to undergo conization should be carefully weighed against a patient's future fertility plans [9,10]. For these reasons, patients with abnormal cytology have been managed according to the American Society for Colposcopy and Cervical Pathology (ASCCP) guideline for over 30 years.…”

Section: Introductionmentioning

confidence: 99%

“…Because of this the feasibility and advantage of the single-step strategy has been discussed in many studies [10]. Based on the findings from these studies, ASCCP updated their recommendation in 2006 to include the ‘see-and-treat' strategy as an alternative to the stepwise protocol in patients with HSIL cytology.…”

Section: Introductionmentioning

confidence: 99%

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

Kim

Lee

Kang

et al. 2014

Gynecol Obstet Invest

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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.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

Kim

Lee

Kang

et al. 2014

Gynecol Obstet Invest

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“…Regular follow-up for each six month period in the first year and then annually are performed for patients who have undergone LEEP. Even though 17% rate of recurrence was reported in patients with negative surgical margin after LEEP was performed, only 4% of our patients with no surgical margin involvement recurred within 31 months' follow-up [3]. This low recurrence rate may be related to the short follow-up period.…”

Section: Discussioncontrasting

confidence: 60%

“…Due to the fact that development of cervical carcinoma occurs over a long period, which may permit an early diagnosis and treatment of precancerous cervical lesions, cytology-based screening programs have significantly reduced the incidence of the disease [2]. Women with an abnormal Pap smear result undergo colposcopic examination and colposcopic-guided biopsy, and, through this standard procedure, cervical cancer may be prevented [3]. In case of a suspicious finding for cervical intraepithelial neoplasia (CIN) 2+ on colposcopy, loop electrosurgical excision procedure (LEEP), a safe and effective treatment modality that is used in the removal of cervical dysplasia, can be offered to the patient instead of cervical biopsy for diagnosis and treatment of the disease.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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Results: Overtreatment rate was found to be 46.6%, decreasing with higher grade of cervical smear abnormalities. Age more than 45, low grade of cervical cytologic abnormality and absence of glandular involvement were associated with higher overtreatment rates. The more advanced the histopathology, the more increased risk of surgical margin on LEEP and ECC positivity (p < 0.0001, for both). Glandular involvement was associated with both surgical margin and ECC positivity.Conclusions: S & T can be used in patients with high grade cytologic anomaly with an acceptable overtreatment rate. In addition, bigger pieces of specimens may need to be removed during LEEP in patients who have suspicious images of higher grade of abnormalities on colposcopy to reduce surgical margin or ECC positivity. When high rate of ECC positivity in patients with HSIL cytology is considered, we suggest performing ECC to every patients with HSIL.

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See-and-Treat Loop Electrosurgical Excision Procedure for High-Grade Cervical Cytology: Are We Overtreating?

Kuroki¹,

Bergeron²,

Gao

et al. 2016

J Low Genit Tract Dis

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Objectives To report the overtreatment rate for see-and-treat versus 3-step conventional strategy (cervical cytology, colposcopic biopsies, then LEEP) for patients with high-grade squamous intraepithelial lesion (HSIL) cytology. Our second aim was to identify risk factors for overtreatment. Methods We included 178 women with HSIL cytology from our university-based colposcopy clinic who underwent LEEP between 2007 and 2014. Overtreatment was defined as cervical intraepithelial neoplasia (CIN) 1 or less on LEEP specimen. Differences between treatment groups were compared using Chi-square test, two-sample t-test or Mann-Whitney rank-sum test as appropriate. Results CIN2+ was found in 69 (80%) of women in the see-and-treat group and 69 (75%) of the conventional management group (p = 0.093), with overtreatment in 17 (20%) and 23 (25%, p=0.403) respectively. Women who underwent see-and-treat (n=86) were older (mean age 36 vs. 31 years, p=0.007) and a greater proportion completed childbearing (30% vs. 13%, p=0.024). There were no differences in top hat excision; however, a higher proportion of the see-and-treat group had CIN2+ in endocervical samples (54% vs. 27%, p=0.047). Overtreatment, regardless of management strategy, was associated with age at time of LEEP, where older women were more likely to be overtreated (median age 37 vs. 32 years respectively, OR 1.04, 95% CI 1.01–1.08 p=0.011). Conclusions A see-and-treat strategy minimizes risk of loss to follow-up with a similar overtreatment rate compared to conventional management. With CIN2+ in some three-fourths of women with HSIL, a see-and-treat should be favored especially when adherence to follow-up is questionable.

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The “see and treat” strategy for identifying cytologic high‐grade precancerous cervical lesions among low‐income Brazilian women

Abstract: For cytologic HSIL, the benefits of the strategy of "see and treat" by LEEP outweighed the risk of overtreatment. Patients with both positive and negative margins on LEEP should be followed carefully.

Cited by 10 publications

References 15 publications

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

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

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

See-and-Treat Loop Electrosurgical Excision Procedure for High-Grade Cervical Cytology: Are We Overtreating?

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