Assessing the see-and-treat approach for the management of high-grade squamous intraepithelial cervical lesions

Abstract

Objectives: To assess local histological outcomes in patients with HSIL cytology results on cervical smears, in both the see-and-treat and three-step approach. Study Design: A retrospective analysis of patients with HSIL on cervical cytology was performed, obtaining an 83 patient cohort. The histological result following the primary investigation (colposcopic-directed biopsy or excisional procedure) was noted for each patient together with their demographic variables and HPV status. Results: Of 83 patients with HSIL cytology on cervical smear, 43 underwent LLETZ as a primary procedure, while 40 patients underwent a colposcopic-directed biopsy. There was no statistically significant difference in terms of dermographics and HPV status between the two groups. In those patients who had LLETZ as a primary procedure, 29 had CIN2+ on histology. On the other hand, following colposcopic-directed biopsies, 17 resulted in CIN2+ on histology. Conclusion: The conventional approach within our local setting potentially has inferior sensitivity in picking up CIN2+ lesions when compared to the see-and-treat approach. On the other hand, primary excisional procedures were associated with an overtreatment rate of at least 20.9%, subjecting patients to unnecessary risks. Local improvement of colposcopic skill will aid to reduce this overtreatment rate and missed lesions at biopsy.