Does a family physician who offers colposcopy and LEEP need to refer patients to a gynecologist?
BACKGROUND
Many family physicians perform colposcopy and provide treatment when biopsy reveals dysplasia. Before the adoption of loop electrical excision procedure (LEEP) gynecologic referral following colposcopy was required for a small percentage of women--most commonly for cold cone procedures. The use of LEEP and LEEP cones may obviate the need for cold conization, so we sought to assess the pattern of gynecologic referral in the practice of family physicians skilled in this procedure.


METHODS
We reviewed the referral practices of a family medicine residency practice that routinely provides LEEP for biopsy-proven cervical intraepithelial neoplasia requiring treatment. Colposcopy and, when indicated, LEEP were performed primarily by the senior author or by residents under close faculty supervision. The computerized clinic log was reviewed for all patients from its 1993 inception through November 1999, and all treatment decisions were evaluated.


RESULTS
During the study period, 283 women were seen in the clinic, and 26 individuals (9%) were referred by the family physician colposcopist to a consulting gynecologist.


CONCLUSIONS
Despite use of LEEP, a minority of patients continues to need gynecologic referral. Large acetowhite lesions extending onto the vaginal fornix accounted for the majority of referrals, and some patients were referred exclusively for cold cone biopsy. Although LEEP can allow family physicians to manage cases previously requiring referral, we urge that this procedure be employed only by those with the technical and decision-making skills required for safe and effective treatment.
Callaway
P
P
Department of Family and Community Medicine, Kansas University School of Medicine, Witchita, USA.
Frisch
L
L
D000554:Ambulatory Care Facilities; D001706:Biopsy / Q000379:methods; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D004598:Electrosurgery / Q000379:methods; D005194:Family Practice; D005260:Female; D006176:Gynecology; D006801:Humans; D007615:Kansas; D011247:Pregnancy; D012017:Referral and Consultation; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*