A “See and Treat” Management for High-Grade Squamous Intraepithelial Lesion Pap Smears

Abstract

The authors performed a chart review of 100 patients with a cervical smear showing high-grade squamous intraepithelial lesion (HSIL) and found that more than 90% of these patients were treated with large loop excision ofthe transformation zone (LLETZ). Typically, management of patients with HSIL involved a clinic visit for the Pap smear, a second visit for colposcopy and biopsy, and a third visit for LLETZ. Only 70% of the patients in the chart review returned for colposcopy, and only 57% showed up for the LLETZ appointment. A prospective study of the next 100 consecutive patients with the same criteria as the initial 100 (nonpregnant, no visible lesion, and negative HIV status) was conducted to evaluate see and treat management of women with HSIL Pap smears. In this protocol, colposcopy and LLETZ are performed at the same visit. Histologic results of the study group showed 94 patients with cervical intraepithelial neoplasia (CIN) 2 or 3, 3 patients with microinvasive cancer, 2 patients with CIN 1, and one patient who had no disease. Eighty-two of the 100 patients came for the initial combined colposcopy and LLETZ appointment. A cost-comparison analysis found that see and treat management saved approximately $350 per patient.