title: Treatment of high-grade squamous intraepithelial lesions: a 2- versus 3-step approach.
abstract: OBJECTIVE
  The purpose of this study was to determine whether colposcopically directed biopsy is a necessary step in the evaluation of patients with high-grade squamous intraepithelial lesions.
  
  
  METHODS
  A retrospective analysis was conducted of the correlation between the high-grade squamous intraepithelial lesion Papanicolaou test and the colposcopically directed biopsy and the correlation between the high-grade squamous intraepithelial lesion Papanicolaou test and the loop electrosurgical excisional procedure.
  
  
  RESULTS
  Of 72 patients with high-grade squamous intraepithelial lesions on Papanicolaou test, 48 patients had a pathologic diagnosis on cervical biopsy of CIN II or greater, which provides a 67% correlation between the Papanicolaou test and the colposcopically directed biopsy. Fifty-six patients had a pathologic diagnosis on loop electrosurgical excisional procedure of CIN II or greater, which provides a 78% correlation between the Papanicolaou test and the loop electrosurgical excisional procedure. The median interval between the Papanicolaou test and the definitive treatment was significantly longer (P <.001) when colposcopically directed biopsy was performed before the loop electrosurgical excisional procedure.
  
  
  CONCLUSIONS
  The colposcopically directed loop electrosurgical excisional procedure after a high-grade squamous intraepithelial lesion Papanicolaou test may reduce the time interval between diagnosis and treatment; furthermore, it offers equal correlation when compared with traditional treatment.
authors.affiliation: Departments of Obstetrics and Gynecology, New York Medical College, Valhalla, New York, USA.
authors.forename: Lillian
authors.initials: L
authors.lastname: Berdichevsky
authors.forename: Randye
authors.initials: R
authors.lastname: Karmin
authors.forename: Linus
authors.initials: L
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D003127:Colposcopy / Q000379:methods*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008875:Middle Aged; D009367:Neoplasm Staging; D065006:Papanicolaou Test; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery*