"See-and-treat" loop electrosurgical excision. Has the time come for a reassessment?
OBJECTIVE
To review the results of a policy decision to offer selected women with cervical high grade squamous intraepithelial lesions (HSILs) loop electrosurgical excision (LEEP) at the time of their initial colposcopic evaluation.


METHODS
Sixty-one patients with newly diagnosed cytologic cervical HSIL were evaluated for inclusion in a "see-and-treat" protocol. Fifty of these patients met inclusion criteria and underwent immediate loop excision of the cervical transformation zone at their initial colposcopic visit.


RESULTS
Forty-eight of 50 patients that underwent see-and-treat management at their initial colposcopic evaluation had histologic evidence of cervical dysplasia/neoplasia. The positive predictive value of diagnostic colposcopy in this setting was 96%, with a 95% confidence interval (88-99%). Two patients had no pathologic abnormality, for an overtreatment incidence of 4%.


CONCLUSIONS
The selected use of see-and-treat management of cytologic cervical HSIL is feasible, highly predictive and associated with an extremely low incidence of overtreatment. Such management has the potential to increase patient satisfaction and compliance while drastically reducing health care dollars currently directed toward the management of HSIL. Strong consideration should be given to accepting see-and-treat management as a viable alternative in the care of patients with documented cervical cytologic HSIL.
Irvin
William P
WP
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Department of Pathology, University of Virginia Health Sciences System, Box 800712, Charlottesville, VA 22908, USA. wpi9d@hscmail.mcc.virginia.edu
Andersen
Willie A
WA
Taylor
Peyton T
PT
Stoler
Mark H
MH
Rice
Laurel W
LW
D000293:Adolescent; D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D003127:Colposcopy / Q000592:standards*; D004598:Electrosurgery / Q000706:statistics & numerical data*; D005260:Female; D006176:Gynecology; D006801:Humans; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D014768:Virginia; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*