Abstract

TORRAO, Maria Manuel; REBELO, Teresa  and  MOTA, Fernando. "See and treat" in women with high-grade squamous  intraepithelial lesion: Hospitais da Universidade  de Coimbra (HUC) outcomes: suitable approach?. Acta Obstet Ginecol Port [online]. 2016, vol.10, n.3, pp.208-214. ISSN 1646-5830.

Introduction: The "see and treat" approach is an immediate diagnosis and treatment of cervical intraepithelial neoplasia (CIN) using loop electrosurgical excision procedure (LEEP). However, this approach has some degree of overtreatment rate, which is defined as a negative LEEP histology. This study was undertaken to evaluate the overtreatment rate of the "see and treat"  approach in women with high-grade squamous intraepithelial lesion (HSIL) citology, in a tertiary care university hospital. Methods: A total of 44 women with HSIL on cervical citology undergoing colposcopy followed by LEEP, between January 2010 and March 2012, were analyzed in a tertiary center. The statistical analysis was carried out using SPSS computer software version 21. Chi-square test was used to determine the impact of age, menopausal status and colposcopic findings in the overtreatment rate. Results: During the study period, 44 women were analyzed. The mean age was 43 years. A total of 31,8% (n=14) women were postmenopausal. About 50% (n=22) had unsatisfactory colposcopic evaluation. The other 22 colposcopies revealed 18 cases of high grade lesions (81,8%). The LEEP histopathological results were as follows: CIN 2 (34,1%;n=15), CIN 3 (29,5%;n=13), invasive cervical carcinoma (2,3%;n=1), adenocarcinoma in situ (2,3%;n=1), CIN 1 (18,2%;n=8), no CIN (11,3%;n=5) and inconclusive (2,3%;n=1). These findings indicate that a total of 68,2% women with HSIL had high-grade lesions in histology. The overtreatment rate was 13,6%. Conclusions: In our institution, the "see and treat" approach has an overtreatment rate (13,6%) slightly higher than the reported in the literature. Age, menopausal status and colposcopic findings had no statistically significant impact on the overtreatment rate. Regarding the cyto-histologic correlation in this study, it was recorded a total of 68.2 % of high-grade lesions (histologically proven) in cytology HSIL. Due to low rate of complications, the "see and treat" procedure seems to be a safe procedure.

Keywords : High-grade squamous intraepithelial lesion; See and treat; overtreatment.

        · text in Portuguese     · Portuguese ( pdf )