title: Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis.
abstract: BACKGROUND
  Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates.
  
  
  OBJECTIVE
  To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting see-and-treat management.
  
  
  METHODS
  MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12 May 2014.
  
  
  METHODS
  Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included.
  
  
  METHODS
  Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1.
  
  
  RESULTS
  Thirteen studies (n = 4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95% CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95% CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95% CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95% CI 68.1-77.7%).
  
  
  CONCLUSIONS
  The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women.
  
  
  CONCLUSIONS
  See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: R M F
authors.initials: RM
authors.lastname: Ebisch
authors.affiliation: Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands.|Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: M M
authors.initials: MM
authors.lastname: Rovers
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.|Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
authors.forename: R P
authors.initials: RP
authors.lastname: Bosgraaf
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: H W
authors.initials: HW
authors.lastname: van der Pluijm-Schouten
authors.affiliation: Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: W J G
authors.initials: WJ
authors.lastname: Melchers
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: P A J
authors.initials: PA
authors.lastname: van den Akker
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: L F A G
authors.initials: LF
authors.lastname: Massuger
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands.
authors.forename: R L M
authors.initials: RL
authors.lastname: Bekkers
mesh_terms: D000328:Adult; D000368:Aged; D002584:Cervix Uteri / Q000473:pathology*; D003127:Colposcopy / Q000706:statistics & numerical data*; D004598:Electrosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery; D014626:Vaginal Smears; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000601:surgery
keywords: Cervical intraepithelial neoplasia; cervical smear; colposcopy; large loop excision of the transformation zone; overtreatment; see-and-treat