J Gynecol Oncol.  2009 Sep;20(3):164-168. 10.3802/jgo.2009.20.3.164.

Treatment of the patients with abnormal cervical cytology: a "see-and-treat" versus three-step strategy

• Cho H
• Kim JH

• KMID: 2173449
• DOI: http://doi.org/10.3802/jgo.2009.20.3.164

Abstract

OBJECTIVE
To examine the correlation between cervical cytology and final histological results in patients who have undergone loop electrosurgical excision procedure (LEEP) with or without colposcopy-directed biopsy. METHODS: A retrospective review was performed of 829 patients who underwent LEEP for abnormal cervical cytology at Gangnam Severance Hospital between January 2004 and December 2008. Patients were classified to three groups according to cervical cytology and also divided into two groups based on the treatment they received: see-and-treat group and the standard three-step group. Final histological results were compared for the each study group. RESULTS: There were no differences in the final histological results between see-and-treat and three-step group in patients with high-grade squamous intraepithelial lesions (HSIL) cytology (N=523) (p=0.71). However, in patients with low-grade squamous intraepithelial lesions (LSIL)/atypical squamous cells of undetermined significance (ASCUS) (N=257) or normal cytology (N=49), the final histological results were significantly different between see-and-treat and three-step group (p<0.001) and the rate of overtreatment was significantly higher in the see-and-treat group (p<0.001). CONCLUSION: A see-and-treat protocol may be a viable alternative only in patients with HSIL cytology if colposcopic impression is suggestive of cervical intraepithelial neoplasia (CIN) 2 or 3 lesions.

Keyword

See-and-treat; High-grade squamous intraepithelial lesions; Loop electrosurgical excision procedure

MeSH Terms

Biopsy
Cervical Intraepithelial Neoplasia
Humans
Retrospective Studies

Figure

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  Fig. 1 The rate of high-grade lesions (≥CIN2) in final histology according to treatment modalities. There were no significant differences in the rate of final diagnosis of more than CIN2 between see-and-treat and three-step group in patients with HSIL cytology (p=0.51), while there were significant differences in LSIL/ASCUS and normal cytology cases (p<0.001). CIN: cervical intraepithelial neoplasia, SCC: squamous cell carcinoma, HSIL: high-grade squamous intraepithelial lesions, LSIL: low-grade squamous intraepithelial lesions, ASCUS: atypical squamous cells of undetermined significance.

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