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Original Research

Open Access

‘See and treat’ approach for high-grade squamous intraepithelial cervical lesions

  • L.S. Nooij1,*,
  • M.J. Kagie1

1Medical Centre The Hague, Department of Obstetrics and Gynecology, The Hague, The Netherlands

DOI: 10.12892/ejgo2793.2016 Vol.37,Issue 1,February 2016 pp.22-25

Published: 10 February 2016

*Corresponding Author(s): L.S. Nooij E-mail: lsnooij@gmail.com

Abstract

Purpose of investigation: Evaluation of the over-treatment percentage when choosing a 'see and treat' approach in patients with deviant cervical smear test results. Materials and Methods: The authors performed a retrospective chart review among women who were treated for cytological low-grade squamous intraepithelial lesion (LSIL) or high-grade squamous intraepithelial lesion (HSIL) from January 2009 until December 2010. All patients who were treated for deviant Pap-smears were analyzed. Patient characteristics were taken into account when performing the analysis. Data were analyzed using SPSS. Logistic regression was performed to determine the influence of age, smoking, and the reason to perform the Pap-smear. Results: A total of 723 patients with deviant Pap-smear results were analysed. High-grade cervical intraepithelial neoplasia (CIN) was found in 70.3% of the patients with a Pap 3A average dysplasia (lowgrade squamous intraepithelial lesion). This indicates that 29.7% of the patients would be over-treated with a 'see and treat' approach. For Pap 3B (high-grade intra-epithelial lesion) or higher the over-treatment percentage was 6.7% or less. Conclusion: Potential risks of a loop electrosurgical excision procedure (LEEP) on future pregnancies and fertility should be taken into account when treating fertile patients for potential CIN. This should be part of the counseling process of patients with a Pap 3A average dysplasia. A 'see and treat' approach can and probably should be proposed to patients with a Pap 3B or higher.

Keywords

Cervical smear; Colposcopy; Cervical intraepithelial neoplasia; Treatment; Loop electrosurgical excision procedure.

Cite and Share

L.S. Nooij,M.J. Kagie. ‘See and treat’ approach for high-grade squamous intraepithelial cervical lesions. European Journal of Gynaecological Oncology. 2016. 37(1);22-25.

References

[1] Kjellberg L., Tavelin B.: “ ‘See and treat’ regime by LEEP conisation is a safe and time saving procedure among women with cytological high-grade squamous intraepithelial lesion”. Acta Obstet. Gynecol. Scand., 2007, 86, 1140.

[2] Li Z.G., Qian D.Y., Cen JM, Chen GD, Shu YH. Three-step versus “see-and-treat” approach in women with high-grade squamous intraepithelial lesions in a low-resource country”. Int. J. Gynaecol. Obstet., 2009, 106, 202.

[3] Numnum T.M., Kirby T.O., Leath C.A., III., Huh W.K., Alvarez R.D., Straughn J.M., Jr.: “A prospective evaluation of "see and treat" in women with HSIL Pap smear results: is this an appropriate strategy?” J. Low. Genit. Tract. Dis., 2005, 9, 2.

[4] Sadan O., Yarden H., Schejter E., Bilavski E., Bachar R., Lurie S.: “Treatment of high-grade squamous intraepithelial lesions: a "see and treat" versus a three-step approach”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2007, 131, 73.

[5] Wright T.C., Jr., Massad L.S., Dunton C.J., Spitzer M., Wilkinson E.J., Solomon D.: “2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ”. J. Low. Genit. Tract. Dis., 2007, 11, 223.

[6] Lindeque B.G.: “Management of cervical premalignant lesions”. Best. Pract. Res. Clin. Obstet. Gynaecol., 2005, 19, 545.

[7] TOMBOLA Group: “Biopsy and selective recall compared with immediate large loop excision in management of women with low grade abnormal cervical cytology referred for colposcopy: multicentre randomised controlled trial”. BMJ, 2009, 339, b2548.

[8] Bosgraaf R.P., Mast P.P., Struik-van der Zanden P.H., Bulten J., Massuger L.F., Bekkers R.L.: “Overtreatment in a see-and-treat approach to cervical intraepithelial lesions 1”. Obstet. Gynecol., 2013, 121, 1209.

[9] Arbyn M., Kyrgiou M., Simoens C., Raifu A.O., Koliopoulos G., Martin-Hirsch P., et al.: “Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis”. BMJ, 2008, 337, a1284.

[10] Jakobsson M., Gissler M., Paavonen J., Tapper A.M.: “Loop electrosurgical excision procedure and the risk for preterm birth”. Obstet. Gynecol., 2009, 114, 504.

[11] Kyrgiou M., Koliopoulos G., Martin-Hirsch P., Arbyn M., Prendiville W., Paraskevaidis E.: “Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis”. Lancet, 2006, 367, 489.

[12] Werner C.L., Lo J.Y., Heffernan T., Griffith W.F., McIntire D.D., Leveno K.J.: “Loop electrosurgical excision procedure and risk of preterm birth”. Obstet. Gynecol., 2010, 115, 605.

[13] Crane J.M.: “Pregnancy outcome after loop electrosurgical excision procedure: a systematic review”. Obstet. Gynecol., 2003, 102, 1058.

[14] Samson S.L., Bentley J.R., Fahey T.J., McKay D.J., Gill G.H.: “The effect of loop electrosurgical excision procedure on future pregnancy outcome”. Obstet. Gynecol., 2005, 105, 325.

[15] Jakobsson M., Gissler M., Tiitinen A., Paavonen J., Tapper A.M.: “Treatment for cervical intraepithelial neoplasia and subsequent IVF deliveries”. Hum. Reprod., 2008, 23, 2252.

[16] Conner S.N., Frey H.A., Cahill A.G., Macones G.A., Colditz G.A., Tuuli M.G.: “Loop electrosurgical excision procedure and risk of preterm birth: a systematic review and meta-analysis 1”. Obstet. Gynecol., 2014, 123, 752.

[17] Bigrigg A., Haffenden D.K., Sheehan A.L., Codling B.W., Read M.D.: “Efficacy and safety of large-loop excision of the transformation zone”. Lancet, 1994, 343, 32.

[18] Brun J.L., Youbi A., Hocke C.: “Complications, sequellae and outcome of cervical conizations: evaluation of three surgical technics”. J. Gynecol. Obstet. Biol. Reprod. (Paris), 2002, 31, 558.

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