open access
See and treat strategy by LEEP conization in patients with abnormal cervical cytology
Affiliations- Medical Faculty, Istanbul University Cerrahpasa, Turkey
- Istanbul University Cerrahpasa Medical Faculty
open access
Abstract
Objectives: To determine the overtreatment and re-LEEP rates of see and treat strategy (S & T) in women who underwent S & T by LEEP and to identify the risk factors for overtreatment and surgical margin and/or endocervical curettage positivity.
Material and methods: A total of 800 patients who underwent S & T in Istanbul University Cerrahpasa Medical Faculty between June 2010 and June 2016 were retrospectively analyzed.
Results: Overtreatment rate was found to be 46.6%, decreasing with higher grade of cervical smear abnormalities. Age more than 45, low grade of cervical cytologic abnormality and absence of glandular involvement were associated with higher overtreatment rates. The more advanced the histopathology, the more increased risk of surgical margin on LEEP and ECC positivity (p < 0.0001, for both). Glandular involvement was associated with both surgical margin and ECC positivity.
Conclusions: S & T can be used in patients with high grade cytologic anomaly with an acceptable overtreatment rate. In addition, bigger pieces of specimens may need to be removed during LEEP in patients who have suspicious images of higher grade of abnormalities on colposcopy to reduce surgical margin or ECC positivity. When high rate of ECC positivity in patients with HSIL cytology is considered, we suggest performing ECC to every patients with HSIL.
Abstract
Objectives: To determine the overtreatment and re-LEEP rates of see and treat strategy (S & T) in women who underwent S & T by LEEP and to identify the risk factors for overtreatment and surgical margin and/or endocervical curettage positivity.
Material and methods: A total of 800 patients who underwent S & T in Istanbul University Cerrahpasa Medical Faculty between June 2010 and June 2016 were retrospectively analyzed.
Results: Overtreatment rate was found to be 46.6%, decreasing with higher grade of cervical smear abnormalities. Age more than 45, low grade of cervical cytologic abnormality and absence of glandular involvement were associated with higher overtreatment rates. The more advanced the histopathology, the more increased risk of surgical margin on LEEP and ECC positivity (p < 0.0001, for both). Glandular involvement was associated with both surgical margin and ECC positivity.
Conclusions: S & T can be used in patients with high grade cytologic anomaly with an acceptable overtreatment rate. In addition, bigger pieces of specimens may need to be removed during LEEP in patients who have suspicious images of higher grade of abnormalities on colposcopy to reduce surgical margin or ECC positivity. When high rate of ECC positivity in patients with HSIL cytology is considered, we suggest performing ECC to every patients with HSIL.
Keywords
cervical intraepithelial neoplasia, conization, smear
About this articleTitle
See and treat strategy by LEEP conization in patients with abnormal cervical cytology
Journal
Issue
Article type
Research paper
Pages
349-354
Published online
2017-07-31
Page views
1804
Article views/downloads
1711
DOI
Pubmed
Bibliographic record
Ginekol Pol 2017;88(7):349-354.
Keywords
cervical intraepithelial neoplasia
conization
smear
Authors
Fuat Demirkiran
Ilker Kahramanoglu
Hasan Turan
Nevin Yilmaz
Aslihan Yurtkal
Elif Meseci
Tugan Bese
Sennur Ilvan
Macit Arvas
References (25)- Ferlay J, Soerjomataram I, Ervik M, et al. GLOBOCAN 2012 v1. 0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11.
- Smith HJ, Leath CA, Huh WK, et al. See-and-treat for high-grade cytology: do young women have different rates of high-grade histology? J Low Genit Tract Dis. 2016; 20(3): 243–246.
- Nogara PRB, Manfroni LAR, da Silva MC, et al. The "see and treat" strategy for identifying cytologic high-grade precancerous cervical lesions among low-income Brazilian women. Int J Gynaecol Obstet. 2012; 118(2): 103–106.
- Massad LS. New guidelines on cervical cancer screening: more than just the end of annual Pap testing. J Low Genit Tract Dis. 2012; 16(3): 172–174.
- Moss EL, Hadden P, Douce G, et al. Is the colposcopically directed punch biopsy a reliable diagnostic test in women with minor cytological lesions? J Low Genit Tract Dis. 2012; 16(4): 421–426.
- Chigbu CO, Onyebuchi AK. See-and-treat management of high-grade squamous intraepithelial lesions in a resource-constrained African setting. Int J Gynaecol Obstet. 2014; 124(3): 204–206.
- Monteiro AC, Russomano F, Reis A, et al. Effectiveness of see-and-treat for approaching pre-invasive lesions of uterine cervix. Rev Saude Publica. 2009; 43(5): 846–850.
- Lindeque BG. Management of cervical premalignant lesions. Best Pract Res Clin Obstet Gynaecol. 2005; 19(4): 545–561.
- World Health Organization. WHO guidelines for screening and treatment of precancerous lesions for cervical cancer prevention. http://www.who.int/reproductivehealth/publications/cancers/screening_and_treatment_of_precancerous_lesions/en/index.html. Updated 2013. Accessed 01.12.2016.
- Wong ASM, Li WH, Cheung TH. Predictive factors for residual disease in hysterectomy specimens after conization in early-stage cervical cancer. Eur J Obstet Gynecol Reprod Biol. 2016; 199: 21–26.
- Solomon D, Davey D, Kurman R, et al. Forum Group Members, Bethesda 2001 Workshop. The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA. 2002; 287(16): 2114–2119.
- Cho H, Kim JH. Treatment of the patients with abnormal cervical cytology: a "see-and-treat" versus three-step strategy. J Gynecol Oncol. 2009; 20(3): 164–168.
- Kietpeerakool C, Cheewakriangkrai C, Suprasert P, et al. Feasibility of the 'see and treat' approach in management of women with 'atypical squamous cell, cannot exclude high-grade squamous intraepithelial lesion' smears. J Obstet Gynaecol Res. 2009; 35(3): 507–513.
- Ebisch RMF, Rovers MM, Bosgraaf RP, et al. Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis. BJOG. 2016; 123(1): 59–66.
- Massad LS, Einstein MH, Huh WK, et al. 2012 ASCCP Consensus Guidelines Conference, 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013; 17(5 Suppl 1): S1–S27.
- Guldeniz AD, Turkan G, Murat BC. Is the loop electrosurgical excision procedure necessary for minor cervical cytological abnormalities? Asian Pac J Cancer Prev. 2014; 15(1): 305–308.
- Li ZG, Qian DeY, Cen JM, et al. Three-step versus "see-and-treat" approach in women with high-grade squamous intraepithelial lesions in a low-resource country. Int J Gynaecol Obstet. 2009; 106(3): 202–205.
- Massad LS, Einstein MH, Huh WK, et al. 2012 ASCCP Consensus Guidelines Conference, 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013; 17(5 Suppl 1): S1–S27.
- Luesley D, Leeson S. Colposcopy and Programme Management. Guidelines for the NHS Cervical Screening Programme. NHSCSP Publication, no. 20. Sheffield, UK: NHSCSP; 2010.
- Bosgraaf RP, Mast PP, Struik-van der Zanden PH, et al. Overtreatment in a see-and-treat approach to cervical intraepithelial lesions. Obstet Gynecol. 2013; 121(6): 1209–1216.
- Kim JiYe, Lee DH, Kang JH, et al. The overtreatment risk of see-and-treat strategy in management of abnormal cervical cytology. Gynecol Obstet Invest. 2014; 78(4): 239–243.
- Ghaem-Maghami S, Sagi S, Majeed G, et al. Incomplete excision of cervical intraepithelial neoplasia and risk of treatment failure: a meta-analysis. Lancet Oncol. 2007; 8(11): 985–993.
- Park JY, Lee KH, Dong SM, et al. The association of pre-conization high-risk HPV load and the persistence of HPV infection and persistence/recurrence of cervical intraepithelial neoplasia after conization. Gynecol Oncol. 2008; 108(3): 549–554.
- Ayhan A, Tuncer HA, Reyhan NH, et al. Risk factors for residual disease after cervical conization in patients with cervical intraepithelial neoplasia grades 2 and 3 and positive surgical margins. Eur J Obstet Gynecol Reprod Biol. 2016; 201: 1–6.
- Chen Y, Lu H, Wan X, et al. Factors associated with positive margins in patients with cervical intraepithelial neoplasia grade 3 and postconization management. Int J Gynaecol Obstet. 2009; 107(2): 107–110.
