EFFICACY OF SEE AND TREAT IN A CERVICAL SCREENING PROGRAM WITH VISUAL INSPECTION WITH ACETIC ACID (VIA)

Abstract

SEE and TREAT at Colposcopy has been described in cytology based screening when a high-grade lesion in association with a high grade abnormality in the Pap smear is treated by Large Loop Excision of the Transformation Zone (LLETZ) to minimize loss to follow-up in the multiple step management protocol for CIN. With a vast burden of cervical cancerin developing countries, our aim was to study the efficacy of this approach in patients coming to colposcopy clinic after a positive VIA test. Women in the age group of 25-50years and coming to the general gynecology clinichad opportunistic screening with VIA those who were found VIA+ underwent Colposcopy. Ifcolposcopy suggested a high-grade lesion, SEE and TREAT using LLETZ was performed.Colposcopy was carried out for 688VIA positive womenof whom 101 had a high-grade lesion and underwent LLETZ. All of them had CIN on histopathology. Thirty-five (34.6%) had CIN 1, 55 (54.5%) had CIN 2 and 11 (10.9%) has CIN 3. Treatment was described as effective if there was CIN of any grade in the LLETZ specimen overtreatment if there was no CIN. The SEE and TREAT approach was effective in all with no overtreatment. Complete excision was achieved in 96.04%women, 3.96% had positive resection margin.There were no major complications. Thus we conclude that a SEE AND TREAT approach in a low-resource setting with VIA followed by Colposcopy and treatment can help in reducing the number of visits and loss to follow-up.