title: See-and-Treat Loop Electrosurgical Excision Procedure for High-Grade Cervical Cytology: Are We Overtreating?
abstract: OBJECTIVE
  To report the overtreatment rate for see-and-treat versus 3-step conventional strategy (cervical cytology, colposcopic biopsies, then LEEP) for patients with high-grade squamous intraepithelial lesion (HSIL) cytology. Our second aim was to identify risk factors for overtreatment.
  
  
  METHODS
  We included 178 women with HSIL cytology from our university-based colposcopy clinic who underwent LEEP between 2007 and 2014. Overtreatment was defined as cervical intraepithelial neoplasia (CIN) 1 or less on LEEP specimen. Differences between treatment groups were compared using chi-square test, 2-sample t test, or Mann-Whitney rank-sum test as appropriate.
  
  
  RESULTS
  CIN2+ was found in 69 (80%) of women in the see-and-treat group and 69 (75%) of the conventional management group (P = 0.093), with overtreatment in 17 (20%) and 23 (25%, P = 0.403), respectively. Women who underwent see-and-treat (n = 86) were older (mean age, 36 vs 31 years; P = 0.007), and a greater proportion completed childbearing (30% vs 13%, P = 0.024). There were no differences in top hat excision; however, a higher proportion of the see-and-treat group had CIN2+ in endocervical samples (54% vs 27%, P = 0.047). Overtreatment, regardless of management strategy, was associated with age at time of LEEP, where older women were more likely to be overtreated (median age, 37 vs 32 years, respectively; OR, 1.04; 95% CI, 1.01-1.08; P = 0.011).
  
  
  CONCLUSIONS
  A see-and-treat strategy minimizes risk of loss to follow-up with a similar overtreatment rate compared with conventional management. With CIN2+ in some three-fourths of women with HSIL, a see-and-treat should be favored especially when adherence to follow-up is questionable.
authors.affiliation: 1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, Missouri; and 2Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine. St. Louis, Missouri.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Kuroki
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Bergeron
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Premal H
authors.initials: PH
authors.lastname: Thaker
authors.forename: Leslie S
authors.initials: LS
authors.lastname: Massad
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D004598:Electrosurgery / Q000706:statistics & numerical data*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D000069342:Medical Overuse; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*