A Prospective Evaluation of ???See and Treat??? in Women With High-Grade Intraepithelial Neoplasia Pap Smear Results: Is This an Appropriate Strategy?

Abstract

The “see and treat” method of cervical screening combines the diagnosis and treatment of premalignant cervical abnormalities by performing a loop electrosurgical excision procedure (LEEP) during the initial screening visit. Because this method may lead to overtreatment of some patients, the authors investigated the incidence of cervical intraepithelial neoplasia (CIN) 2 and CIN 3 in women with Pap smear diagnoses of high-grade intraepithelial neoplasia (HSIL). Study participants were recruited from 139 women referred for evaluation of Pap smear results showing HSIL (CIN 2, ie, moderate dysplasia under the old classification). Of a total of 139 patients initially referred, 77 kept their clinic appointment for evaluation. Fifty-one of these women who met study criteria, which included a minimum age of 19 years and clinically suitability for LEEP, agreed to participate in the study. All participants underwent a colposcopic examination before LEEP to rule out invasive cancer. A Reid colposcopic index score was generated for each patient. The study patients, of whom 24 were black, 25 white, and 1 was Hispanic, were an average age of 26 years (range, 19–45 years). Colposcopic examinations were considered satisfactory in 43 of the 51 patients, and no indications of invasive disease were found. The average Reid colposcopic index score was 3.5 (range, 0–7). Four patients (8%) each had no CIN or CIN 1 in their histology specimen. CIN 2 was found in 18 patients (35%), and CIN 3 was diagnosed in 25 (49%). Therefore, 16% of patients in this series had CIN 1 or less and were overtreated. A logistic regression analysis of patient characteristics was performed. Nulliparous women had 12.4 times the risk of being overtreated with see and treat screening than nulliparous women (odds ratio, 12.4; 95% confidence interval, 1.61–90).