Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix.
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.
Departamento de Ginecologia, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil. acsmont@uol.com.br
Aparecida Cristina Sampaio
AC
Monteiro
Fábio
F
Russomano
Aldo
A
Reis
Maria José de
MJ
Camargo
Susana Aidé
SA
Fialho
Maria Aparecida
MA
Tristão
Thiers
T
Soares
D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D003127:Colposcopy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D009361:Neoplasm Invasiveness; D018307:Neoplasms, Squamous Cell / Q000473:pathology / Q000601:surgery; D011320:Primary Health Care / Q000458:organization & administration; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery