title: Uterine cervix conization based on Pap smear results: the "see and treat" approach.
abstract: BACKGROUND
  The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens patient anxiety, and reduces health care costs.
  
  
  OBJECTIVE
  To evaluate the level of diagnostic accuracy and the over-treatment rate in the "see and treat" versus conventional management of women diagnosed with HGSIL.
  
  
  METHODS
  We retrospectively reviewed all women with HGSIL who had undergone the "see and treat" approach during 2001-2011 at Soroka University Medical Center. Similar cohorts, who were managed conventionally with a cervical biopsy prior to the conization, served as a comparison group.
  
  
  RESULTS
  The study population consisted of 403 women: 72 (18%) had undergone the "see and treat" approach and 331 (82%) conventional management. The false positive rate was 11% for the "see and treat" group, compared to 6% for the conventional management group (P = 0.162). Similarly, no statistically significant difference was observed when comparing the positive predictive value (PPV) of high grade dysplasia diagnosed on Pap smear (PPV 88.9%) versus cervical biopsy (PPV 93.8%) (P = 0.204). Moreover, both the false positive rate and PPV remained similar in subgroups of patients, according to age, menopausal status, number of births, and colposcopy findings.
  
  
  CONCLUSIONS
  The accuracy level of HGSIL diagnosis on Pap smear is similar to that of high grade dysplasia on a cervical biopsy. We therefore recommend referring patients with HGSIL directly to conization. Skipping the biopsy step was not associated with significant over-treatment or other adverse effects.
authors: Mihai
authors: M
authors: Meirovitz
authors: Dvir
authors: D
authors: Gatt
authors: Jacob
authors: J
authors: Dreiher
authors: Ruthy
authors: R
authors: Shaco-Levy
mesh_terms: D000328:Adult; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery; D019092:Conization / Q000379:methods*; D017046:Cost Savings; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D005260:Female; D006300:Health Services Misuse / Q000191:economics / Q000517:prevention & control; D006801:Humans; D007557:Israel / Q000453:epidemiology; D065006:Papanicolaou Test / Q000379:methods* / Q000706:statistics & numerical data; D010346:Patient Care Management / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D061665:Time-to-Treatment; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery; D014626:Vaginal Smears / Q000379:methods / Q000706:statistics & numerical data; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology / Q000601:surgery