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See-and-Treat Loop Electrosurgical Excision Procedure for High-Grade Cervical Cytology: Are We Overtreating?

Kuroki, Lindsay M. MD; Bergeron, Lauren M. MD; Gao, Feng PhD, MPH; Thaker, Premal H. MD, MS; Massad, Leslie S. MD

Journal of Lower Genital Tract Disease: July 2016 - Volume 20 - Issue 3 - p 247–251
doi: 10.1097/LGT.0000000000000230
Original Research Articles: Cervix and HPV

Objectives To report the overtreatment rate for see-and-treat versus 3-step conventional strategy (cervical cytology, colposcopic biopsies, then LEEP) for patients with high-grade squamous intraepithelial lesion (HSIL) cytology. Our second aim was to identify risk factors for overtreatment.

Methods We included 178 women with HSIL cytology from our university-based colposcopy clinic who underwent LEEP between 2007 and 2014. Overtreatment was defined as cervical intraepithelial neoplasia (CIN) 1 or less on LEEP specimen. Differences between treatment groups were compared using chi-square test, 2-sample t test, or Mann-Whitney rank-sum test as appropriate.

Results CIN2+ was found in 69 (80%) of women in the see-and-treat group and 69 (75%) of the conventional management group (P = 0.093), with overtreatment in 17 (20%) and 23 (25%, P = 0.403), respectively. Women who underwent see-and-treat (n = 86) were older (mean age, 36 vs 31 years; P = 0.007), and a greater proportion completed childbearing (30% vs 13%, P = 0.024). There were no differences in top hat excision; however, a higher proportion of the see-and-treat group had CIN2+ in endocervical samples (54% vs 27%, P = 0.047). Overtreatment, regardless of management strategy, was associated with age at time of LEEP, where older women were more likely to be overtreated (median age, 37 vs 32 years, respectively; OR, 1.04; 95% CI, 1.01–1.08; P = 0.011).

Conclusions A see-and-treat strategy minimizes risk of loss to follow-up with a similar overtreatment rate compared with conventional management. With CIN2+ in some three-fourths of women with HSIL, a see-and-treat should be favored especially when adherence to follow-up is questionable.

See-and-treat loop electrosurgical excision procedure strategy for managing high-grade squamous intraepithelial lesions cytology requires fewer visits, less opportunity for default, and overtreatment rates similar to a 3-step conventional strategy.

1Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine, and Alvin J. Siteman Cancer Center, St. Louis, Missouri; and 2Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine. St. Louis, Missouri

Reprint requests to: Lindsay M. Kuroki, MD, Department of Obstetrics and Gynecology, 4911 Barnes Jewish Hospital Plaza, Box 8064, St. Louis, MO. E-mail:

The authors have declared they have no conflicts of interest.

Support: Postdoctoral Mentored Training Program in Clinical Investigation is sponsored by UL1 TR000448. The Alvin J. Siteman Cancer Center is supported in part by an NCI Cancer Center Support Grant P30 CA091842, Eberlein, PI.

Institutional Review Board approval: Obtained on March 9, 2015, by Washington University’s Human Research Protection Office (IRB Project No. 201503011).

Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Dr Bradley Evanoff is the PI for the Clinical and Translational Science Award that supports all Washington University ITCS and Clinical Research Training Center activities.

Copyright © 2016 by the American Society for Colposcopy and Cervical Pathology