title: The overtreatment risk of see-and-treat strategy in management of abnormal cervical cytology.
abstract: BACKGROUND
  To evaluate the feasibility of conization without a prior punch biopsy for patients with abnormal cytology.
  
  
  METHODS
  A retrospective review was performed for 700 patients who underwent conization at a single institution from January 2003 to August 2012. Each of these patients was assigned to one of two groups, either the 'see-and-treat' group or the 'three-step' group, depending on whether the patient had undergone a punch biopsy before conization or not. The final histologic results of two groups were compared.
  
  
  RESULTS
  The overtreatment risk was higher in the 'see-and-treat' group in patients with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASCUS/LSIL) cytology (64.7% in the 'see-and-treat' group vs. 36.5% in the 'three-step' group; p = 0.001). There was no significant statistical difference in the rate of cervical dysplasia or invasive carcinoma in patients with high-grade squamous intraepithelial lesion (HSIL) cytology between groups (91.8% in the 'see-and-treat' group vs. 93.5% in the 'three-step' group; p = 0.793).
  
  
  CONCLUSIONS
  The patients with HSIL on cytology can be managed by a 'see-and-treat' strategy with a low risk of overtreatment. On the other hand, the 'three-step' management is more appropriate in patients with ASCUS/LSIL cytology.
authors.affiliation: Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Ji Ye
authors.initials: JY
authors.lastname: Kim
authors.forename: Doo Haeng
authors.initials: DH
authors.lastname: Lee
authors.forename: Jun Hyeok
authors.initials: JH
authors.lastname: Kang
authors.forename: Kye Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Kyo Won
authors.initials: KW
authors.lastname: Lee
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D065309:Atypical Squamous Cells of the Cervix; D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology; D003127:Colposcopy; D019092:Conization / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D002577:Uterine Cervical Diseases; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery*; D014626:Vaginal Smears