Treatment of high-grade squamous intraepithelial lesions: A “see and treat” versus a three-step approach

Sadan, Oscar; Yarden, Havazelet; Schejter, Eduardo; Bilevsky, Efi; Bachar, Rachel; Lurie, Samuel

doi:10.1016/j.ejogrb.2005.12.025

Cited by 23 publications

(21 citation statements)

References 5 publications

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“…The overtreatment in other local studies were between 3.6-7 percent if the preceding cytology and colposcopic impression revealed high grade abnormality (Table 4). Our investigation showed 75 percent correlation rate between cytology and histology compared to 70.1-92.2 percents in other local works (Charoenkwan et al, 2004;Suntornlimsiri., 2004;Sadan et al, 2007;Kietpeerakool et al, 2007;Aue-Aungkul et al, 2011;Nogara et al, 2012;Ingkapairoj et al, 2012). Majority of Pap smear reports in this study (97 percents) came from affiliated health care providers who were a part of our health consortium.…”

Section: Discussionmentioning

confidence: 76%

See-and-Treat Approach to Cervical Intraepithelial Lesions in HRH Princess Maha Chakri Sirindhorn Medical Center

Srisuwan

Hamontri²,

Kongsomboon³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Background: To evaluate the overtreatment rate with the see and treat approach in the management of women with abnormal cervical cytology. Materials and Methods: A retrospective review of patients with abnormal cervical cytology who underwent S&T at MSMC between January 2008 and December 2012 was conducted. Loop electrosurgical excision procedure (LEEP), histological results, cytology and colposcopic impression were analyzed to evaluate overtreatment rate, cyto-histologic correlation and related factors. Results: Average age of S&T cases was 42 years. Ninety seven percents were referred from affiliated health care providers. The study revealed 83.2% patients had HSIL or higher from cervical cytology. Correlation between HSIL and final histology was relatively low at 75% compared to other studies. Overtreatment rate was 28%. Conclusions: S&T was done in 197 patients in a tertiary care health facility with patient satisfaction. Overtreatment occurred, but the rate can be reduced with appropriate recommendations. HSIL Pap smears should be reexamined before S&T while low grade and lesser colposcopic impression groups should obtain conventional colposcopic approach for patient future reproductive benefit.

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Section: Discussionmentioning

confidence: 76%

See-and-Treat Approach to Cervical Intraepithelial Lesions in HRH Princess Maha Chakri Sirindhorn Medical Center

Srisuwan

Hamontri²,

Kongsomboon³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…This saving should be weighted against the cost of overtreatment in further economic analysis studies. Sadan et al (2007) 10 concluded that S&T approach may shorten the time between diagnosis and treatment with similar accuracy of diagnosis compared to the traditional protocol (prior biopsy).…”

Section: Discussionmentioning

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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“…Diagnostic cervical excision is advised if the colposcopic examination is inadequate, microinvasive carcinoma or low-grade lesion is identified on colposcopically-directed biopsy. Previous reported incidence of precancerous lesion and invasive cancer among population resided in low cervical cancer incidence areas ranges 60%-80% and 1-3%, respectively (Jones and Davey, 2000;Massad et al, 2001;Szurkus and Harrison, 2003;Berdichevsky et al, 2004;Boman et al, 2004;Numnum et al, 2005;Chute et al, 2006;Sadan et al, 2007). In Thailand, although incidence of CIN2-3 and AIS in women with HSIL smears (62% to 74%) paralleled those reports of other populations, the incidences of underlying invasive disease were remarkably higher ranging from 7.9% to 25.8% (Kantathavorn et al, 2006;Boonlikit, 2008;Aue-Aungkul et al, 2011;Sripipattanakul, 2011;Ingkapairoj et al, 2012;Kingnate, et al, 2014) (Table 2).…”

Section: High-grade Squamous Intraepithelial Lesionmentioning

confidence: 99%

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

Kietpeerakool¹,

Tangjitgamol²,

Srisomboon³

2014

Asian Pacific Journal of Cancer Prevention

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Asian Pac J Cancer Prev, 15 (16), 6489-6494 IntroductionCervical cancer remains the major health problem in Thailand and many other developing countries. This is mainly because of failure to initiate or sustain effective screening strategy. In recent population-based cancer registries, the highest incidence of cervical cancer in Thailand was noted in Chiang Mai with an average agestandardized incidence rate (ASR) of 28.9 per 100000, followed by Lampang (ASR, 22.4) and Bangkok (ASR, 20.9) (Moore et al., 2010).Although high-risk Human Papillomavirus (HR-HPV) test and HPV genotyping have certain role in cervical cancer screening nowadays, these tests are not widely available in developing countries. Cervical cytology is still the principal screening method. Subsequent management of abnormal cervical cytology to detect underlying cervical lesions is also important. Generally, management of abnormal cervical cytology depends on the risk of encountering high-grade cervical disease. However, the risks of high-grade cervical disease encountered in abnormal cervical cytology may vary among different regions of the world and across the country. Therefore, information regarding the incidence of significant cervical disease from different areas or populations is crucial for designing and implementing area-specific management approach. This review was conducted to evaluate the incidence of high-grade cervical diseases among Thai AbstractCervical cytology remains the principal screening method to detect pre-invasive and invasive cervical lesions. Management of abnormal cervical cytology depends on the risk of encountering a significant cervical lesion or high-grade cervical disease. These risks may vary in different areas across the country. Thus, determining the rate of significant cervical lesion associated with each type of abnormal cervical cytology in each area is of critical importance for designing area-specific management approach. This review was conducted to evaluate the rate of high-grade cervical disease among Thai women with abnormal cervical cytology. A relatively high incidence of underlying significant lesions including invasive disease was demonstrated even in those having only minimal smear abnormality. This baseline information is crucial and must be taken into consideration in management of women with abnormal cytological screening to achieve the goals of comprehensive cervical cancer control in Thailand.

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Treatment of high-grade squamous intraepithelial lesions: A “see and treat” versus a three-step approach

Cited by 23 publications

References 5 publications

See-and-Treat Approach to Cervical Intraepithelial Lesions in HRH Princess Maha Chakri Sirindhorn Medical Center

See-and-Treat Approach to Cervical Intraepithelial Lesions in HRH Princess Maha Chakri Sirindhorn Medical Center

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

Histopathological Outcomes of Women with Abnormal Cervical Cytology: a Review of Literature in Thailand

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