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Current events in Obstetrics & Gynecology, updates on new web site features and links to other web sites of interest to ObGyns.

Friday, May 31, 2013

Trailers (50): See-and-treat for CIN

Bosgraaf et al. Overtreatment in a see-and-treat approach to cervical intraepithelial lesions.

Why should you read about this topic?

See-and-treat might be a more efficient approach to high-grade or persistent cervical lesions but at the expense of   overtreatment.

What were the authors trying to do?

To estimate the rate of overtreatment in a see-and-treat protocol for cervical dysplasia

Who participated and in what setting?

Women (N=3192) with abnormal Pap smears who underwent a see-and-treat protocol at the Radboud University Nijmegen Medical Center between 1981-2010

What was the study design?

Retrospective database study

What were the main outcome measures?

Overtreatment (CIN 1 or less at final histopathologic analysis)

What were the results?

18% of women were overtreated.  The lowest overtreatment rate was in women with a high-grade smear and a high-grade colposcopic impression.  The older the woman the greater the rate of overtreatment.

What is the most interesting image in the paper?

Table 2

What were the study strengths and weaknesses?

Strengths: large study size. Weaknesses: database study; long period of study spanning many significant changes in cervical cancer screening; no cytopathology or histopathology review; missing data in over 25%

What does the study contribute for your practice?

See-and-treat seems to work best when you have a colposcopic impression of a high-grade lesion along with a high-grade Pap smear.  Now what we need is a cost-effectiveness analysis of see-and-treat that includes costs of overtreatment.