title: See-and-treat management of high-grade squamous intraepithelial lesions in a resource-constrained African setting.
abstract: OBJECTIVE
  To compare the treatment outcomes of women with high-grade squamous intraepithelial lesions (HSIL) who underwent immediate loop electrosurgical excision procedure (LEEP) and those who had directed biopsies prior to subsequent LEEP.
  
  
  METHODS
  Women who were referred for HSIL to 2 centers in southeast Nigeria were examined via colposcopy. Those with positive colposcopic findings were randomized to receive either immediate LEEP (see-and-treat group) or directed biopsies (3-step group). Women with directed biopsy-confirmed results underwent follow-up LEEP. Overtreatment rate, cost, default rate, and cytology-treatment interval were compared between the 2 groups.
  
  
  RESULTS
  In total, 314 women were included in the study. The overtreatment rate was similar between the groups. Treatment cost and cytology-treatment interval were significantly higher in the 3-step group (P=0.0001). The default rate was significantly lower in the see-and-treat group (P=0.0001). Most (219 [69.7%]) participants preferred the see-and-treat approach.
  
  
  CONCLUSIONS
  Immediate see-and-treat LEEP for women with HSIL in southeast Nigeria is cheaper, less time-consuming, and associated with better patient compliance than the 3-step management procedure. Furthermore, it does not lead to significantly higher overtreatment. The immediate see-and-treat approach may be ideal for the management of women with HSIL in low-resource countries.
authors.affiliation: Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Ituku-Ozalla, Nigeria. Electronic address: chchigbu@yahoo.com.
authors.forename: Chibuike O
authors.initials: CO
authors.lastname: Chigbu
authors.affiliation: Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria.
authors.forename: Azubuike K
authors.initials: AK
authors.lastname: Onyebuchi
mesh_terms: D000328:Adult; D001706:Biopsy; D003127:Colposcopy / Q000379:methods; D003906:Developing Countries; D004598:Electrosurgery / Q000191:economics / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009549:Nigeria; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*
keywords: Africa; High-grade squamous intraepithelial lesions; Loop electrosurgical excision procedure; See and treat