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

Abstract

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, ...

Overtreatment and Cost-Effectiveness of the See-and-Treat Strategy for Managing Cervical Precancer

“…This finding contradicted previous studies from the late 1990s (2, 23). In our analysis, the cost savings from reduced utilization of biopsy were outweighed by the cost of the additional LEEP treatments, as expected by Monteiro and colleagues (4). Using the standard willingness-to-pay threshold of $50,000/QALY (25), our results show that the see-and-treat strategy is not cost-effective compared to usual care.…”

“…Multiple studies have found inadequate follow-up adherence (as low as 30% in certain populations) among patients with biopsy-proven high-grade cervical dysplasia (2, 3). In an attempt to overcome this non-adherence, the see-and-treat protocol was introduced in the mid-1990s as an alternative clinical strategy, i.e., to perform a LEEP of the transformation zone when the colposcopic impression is suggestive of HSIL -- at the same time of the colposcopy visit (4). …”

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

“…In addition, S & T has been shown to decrease patient anxiety, number of medical visits, and travel cost [6]. It may also prevent patient dropout before treatment [7]. Some studies have reported that up to 25% of patients in the three steps strategy did not return for their next visit [8].…”

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

“…Patients welcomed the practice because it decreased patient's anxiety as they received the treatment right away (Chigbu et al, 2014). S&T cuts down on the number of medical visits, saves hospital trip, travel cost and prevents the dropout before treatment (Monteiro et al, 2009). It provides specimens for histologic diagnosis to rule out undetected invasive cancer (Emam et al, 2009).…”