‘See and treat’ regime by LEEP conisation is a safe and time saving procedure among women with cytological high‐grade squamous intraepithelial lesion

Kjellberg, Lennart; Tavelin, Björn

doi:10.1080/00016340701505267

Cited by 25 publications

(26 citation statements)

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“…Our S&T patients verbally stated that they felt relieved that the problem tissues were removed from their bodies in a timely manner. Kjellberg et al (2007) describe in his literature that both of these methods (cytology and cervical directed biopsy) yielded almost the same detection rate (78.5 vs. 73.2%). The question arises if cervical biopsy is still needed to confirm the Pap smear result or can we skip the biopsy and go on with see and treat strategy (Kjellberg et al, 2007).…”

Section: Discussionmentioning

confidence: 95%

“…Kjellberg et al (2007) describe in his literature that both of these methods (cytology and cervical directed biopsy) yielded almost the same detection rate (78.5 vs. 73.2%). The question arises if cervical biopsy is still needed to confirm the Pap smear result or can we skip the biopsy and go on with see and treat strategy (Kjellberg et al, 2007). A total of 75 percents of our patients with HSIL or higher on Pap smear had a corresponding diagnosis at LEEP specimen.…”

Section: Discussionmentioning

confidence: 95%

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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: 95%

Section: Discussionmentioning

confidence: 95%

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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“…El porcentaje de curación, citología y colposcopia normales, con un promedio de 18 meses de seguimiento, en mujeres con LIE de alto grado fue de 85,5%, similar a lo reportado internacional (11,16,17) y nacionalmente (17). Este buen resultado estaría relacionado con la alta frecuencia de erradicación del virus papiloma humano (HPV) después del procedimiento electro quirúrgico (18).…”

Section: Discussionunclassified

Escisión De La Zona De Transformación en Lesiones De Cérvix: Análisis De 1.141 Casos

D¹,

G²,

M³

et al. 2008

Rev. chil. obstet. ginecol.

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RESUMENObjetivo: Analizar los resultados de la escisión de la zona de transformación del cérvix efectuadas en la Unidad de Patología Cervical del Hospital Guillermo Grant de Concepción. Método: Estudio descriptivo, retrospectivo, de los antecedentes clínicos e histológicos de 1.141 casos de escisión electro quirúrgica efectuados entre 1999 a 2005, con seguimiento mínimo de 18 meses. Resultados: De las 3.004 mujeres derivadas por citología positiva para neoplasia y/o HPV, a 1.141 (37,9%) se les realizó escisión de la zona de transformación; 1.113 con asa electroquirúrgica (97,5%) y 28 (2,5%) cono frío con bisturí. Las lesiones intraepiteliales (LIE) de alto grado fueron las más frecuentes (66,7%), seguidas por las LIE de bajo grado (7,8%); el 6,5% de las pacientes presentan etapas iniciales de carcinoma invasor; 33% de las piezas histológicas presentaron bordes comprometidos; 18,4% no presentaron lesión histológica, que sumadas a 7,8% de LIE de bajo grado representan un 26,2% de mujeres consideradas como sobretratadas. El porcentaje a 18 meses de seguimiento en mujeres con LIE de alto grado fue de 85,5%. Necesitaron de una segunda intervención 194 pacientes (17%), 110 (9,6%) por persistencia y recidivas de la lesión. Conclusión: Los resultados presentados son satisfactorios en el porcentaje de curación de las LIE de alto grado como en el aporte al diagnóstico precoz de carcinomas del cérvix y similares a estudios publicados tanto nacionales como extranjeros. /or condyloma, 1,113 (97.5%) were treated with loop electrosurgical excisional procedure (LEEP) and 28 (2.5%) with cold-knife conization. The most frequent lesion (66.7%) found was high grade squamous intraepithelial lesions (SIL), follow by low grade SIL (7.8%); 74 patients (6.5%) presented with early stage of squamous cell carcinoma and 377 (33%) of the histological specimens revealed positive margins; 210 (18.4%) of the cases showed no histological lesion.

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“…11,12 Problems with negative side effects, such as adverse pregnancy outcome, 13 due to overtreatment have favoured a less invasive strategy for further assessment and a more conservative strategy for treatment, whereas the concern of missing severe disease has favoured a more invasive approach, and even diagnostic excisions/ conisations. 9,14 During the last decade, LLETZ has increasingly replaced laser conisation as excisional therapy in Sweden, mostly because of its easy use.…”

mentioning

confidence: 99%

“…5,6 Out of all vaginal cytology in Sweden 1.7% has been reported as atypical squamous cells of undetermined significance (ASCUS), 1.4% as cervical intraepithelial neoplasia grade one (CIN1), 0.9% as CIN2-3, 0.3% as atypia in cells of uncertain origin, and 0.2% as glandular cell atypia and adenocarcinoma/adenocarcinoma in situ (AIS). 8 The major differences in management concern (i) cytological surveillance versus colposcopy and biopsy in low-grade abnormalities, (ii) further investigation by punch biopsies and/or endocervical curettage before treatment versus ''see and treat'', 9,10 (iii) the use of colposcopy versus no use when taking biopsies, and (iv) treatment with excisional methods [cold knife conisation, laser conisation and large loop excision of the transformation zone (LLETZ)], versus ablative methods (laser ablation, cryotherapy and diathermy). 11,12 Problems with negative side effects, such as adverse pregnancy outcome, 13 due to overtreatment have favoured a less invasive strategy for further assessment and a more conservative strategy for treatment, whereas the concern of missing severe disease has favoured a more invasive approach, and even diagnostic excisions/ conisations.…”

mentioning

confidence: 99%

Risk of invasive cervical cancer in relation to clinical investigation and treatment after abnormal cytology: A population‐based case–control study

Silfverdal

Kemetli

Sparén

et al. 2010

Intl Journal of Cancer

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A substantial proportion of women with cervical cancer that have participated in cervical screening have a history of an abnormal cytology result. Our objective was to assess the impact of histological investigation and treatment of women with abnormal cytology on the subsequent risk of invasive cervical cancer. All invasive cervical cancer cases in Sweden 1999Sweden -2001 and five population-based control women per case were investigated. Clinical investigations and treatment were analysed in case women (N 5 143) and control women (N 5 176) below 67 with abnormal cytology results 0.5-6.5 years before the cases' diagnosis. Cervical cancer risk in relation to investigation [histology or not, punch biopsy, cervical curettage or cone/ large loop excision of the transformation zone (LLETZ)], and treatment (treatment or not, excisional or ablative) was estimated as odds ratios (ORs) using logistic regression. Absence of histological assessment was associated with increased cancer risk, both after low-grade [OR 2.37; 95% confidence intervals (CI): 1.27-4.43] and high-grade squamous atypia (8.26; 2.37-28.8). Among women with histology, absence of treatment was associated with increased cancer risk (3.68; 1.53-8.84), also when biopsy showed low-grade atypia or normal findings (3.57; 1.18-10.8). Ablative therapy associated with increased risk compared with excisional (3.82; 1.01-14.4), and laser conisation associated with decreased risk compared with LLETZ (0.06; 0.01-0.36). In conclusion, low-grade as well as high-grade squamous atypical cytology results may warrant histological investigation, treatment reduced cancer risk even when histology was negative or showed low-grade atypia indicating a need for improvements in the diagnosis of high-grade lesions, and laser conisation was the most effective treatment.Screening by cytology has been highly effective in reducing the incidence of invasive cervical cancer by the detection and removal of precursor lesions.

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‘See and treat’ regime by LEEP conisation is a safe and time saving procedure among women with cytological high‐grade squamous intraepithelial lesion

Abstract: An immediate colposcopically-guided LEEP conisation after HSIL Pap smear may be a safe and time saving strategy. Positive cone margins are a risk factor for residual/recurrent disease.

Cited by 25 publications

References 26 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

Escisión De La Zona De Transformación en Lesiones De Cérvix: Análisis De 1.141 Casos

Risk of invasive cervical cancer in relation to clinical investigation and treatment after abnormal cytology: A population‐based case–control study

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