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Factors Related to Overtreatment in the See-and-Treat Approach

A Retrospective Multicentric Observational Study

Ciavattini, Andrea, MD1; Morini, Stefano, MD1; Delli Carpini, Giovanni, MD1; Del Fabro, Anna, MD2; Serri, Matteo, MD1; Verdecchia, Valeria, MD1; Cigolot, Federica, RN2; Cadel, Manuela, RN2; Clemente, Nicolò, MD2; Sopracordevole, Francesco, MD2

Journal of Lower Genital Tract Disease: April 2019 - Volume 23 - Issue 2 - p 129–132
doi: 10.1097/LGT.0000000000000455
HPV-Associated Disease: Diagnosis and Management
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Objective The aim of the study was to evaluate the association between colposcopic features, age, menopausal status, and overtreatment in women subjected to “see-and-treat” approach, to identify subgroups of patients in which this approach could be more appropriate.

Materials and Methods Retrospective multicentric cohort study conducted on women older than 25 years, with a high-grade squamous cytological report and a visible squamocolumnar junction, in which colposcopy and the excisional procedure were performed at the same time without a previous cervical biopsy (see and treat). Overtreatment was defined as histopathological finding of cervical intraepithelial lesion grade 1 or normal tissue.

Results Among the 254 included patients, the overall overtreatment rate was 12.6%, whereas in women with a grade 2 colposcopy, it was 3.2% and, in women with grade 1 colposcopy, it was 22.0%. Among the considered factors (age, menopause, and grade 1 colposcopy), only a positive association with overtreatment and grade 1 colposcopy emerged (odds ratio = 8.70, 95% CI = 2.95–25.62, p < .001).

Conclusions See and treat may be appropriate in women older than 25 years with a visible squamocolumnar junction and a high-grade squamous cervical cytology. Patients need to be informed about the higher risk of overtreatment in case of a grade 1 colposcopic impression, which however may still be considered acceptable. Patient's age and menopausal status should not influence the decision to propose a see-and-treat approach.

1Woman's Health Sciences Department, Università Politecnica delle Marche, Ancona, Italy; and

2Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, Aviano, Italy

Reprint requests to: Andrea Ciavattini, MD, Woman's Health Sciences Department, Università Politecnica delle Marche, Via F. Corridoni, 11-60123 Ancona, Italy. E-mail: ciavattini.a@libero.it

The authors have declared they have no conflicts of interest.

All authors contributed to the conception and design of the study. All authors take responsibility for the integrity of the work and for the approval of the final “to be published” version. A professional linguistic reviewer has revised this article. All authors know and comply with the journal's Conflict of Interest Policy. The present article is not under consideration for publication elsewhere.

Ethics approval for the review of case records was obtained from the Clinical Research Ethics Committee of the “Università Politecnica delle Marche,” and a written informed consent for use of personal data was obtained from each woman.

Copyright © 2019 by the American Society for Colposcopy and Cervical Pathology