The treatment of cervical intra-epithelial neoplasia: when could we ‘see and loop’

Abstract

Objective: To determine the possible role of the selective ‘see and loop’ approach with a loop electrosurgical excision procedure (LEEP) for high grade cervical intra-epithelial neoplasia (CIN). Design: Comparison of the colposcopic and histological diagnosis in patients who received LEEP treatment. Subjects: Subjects included 95 patients from May to October 1994. Setting: Department of Obstetrics and Gynaecology, the Prince of Wales Hospital. the Chinese University of Hong Kong. Main outcome measures: Agreement between colposcopic and histological diagnosis and between histological diagnosis by biopsy and by LEEP. Sensitivity and false positive rate of colposcopic diagnosis in different classifications of high grade CIN lesions. Decision analysis on the cost of three proposed strategies based on the study results. Results: The cloposcopic diagnosis was correct in 58% of cases with 31% overcall and 11% undercall rates. The false positive rate of colposcopic examination was 11.4% in the diagnosis of CIN III or more advanced lesions and 36.8% if CIN II lesions are also classified as high grade. Decision analysis showed a saving of: (i) US$53 000; or (ii) US$73 000 per annum if ‘see and loop’ was performed on all cases where colposcopic diagnosis is: (i) CIN III or more; or (ii) CIN II or more. If the cost of inappropriate surgery by LEEP is estimated to be more than US$550 per person over-treated (i) becomes the preferred strategy. Conclusions: Selective ‘see and loop’ approach for high grade CIN III lesions suspected on colposcopy will not over-treat significantly but will reduce the number of colposcopy appointments, waiting list for colposcopy and subsequent expenses.