Feasibility of the 'see and treat' approach in management of women with 'atypical squamous cell, cannot exclude high-grade squamous intraepithelial lesion' smears

Abstract

Aim: To evaluate the feasibility of the 'see and treat' approach in the management of women with 'atypical squamous cell, cannot exclude high-grade squamous intraepithelial lesion' (ASC-H) on cervical cytology. Methods: All women with ASC-H, who had undergone the see and treat approach between October 2004 and January 2008 at Chiang Mai University Hospital, were reviewed. Similar cohorts, who had undergone conventional management during the same period, were recruited as a comparative group. Results: One-hundred and eight women with ASC-H smears were available for review. Fifty-eight (53.7%) women had undergone see and treat approach and the remaining 50 had undergone conventional management. There was no significant difference in final histological diagnosis between the conventional and the see and treat group (P = 0.32). The time interval from colposcopy to final histological diagnosis in the see and treat group was shorter than that in the conventional group, particularly for women with high-grade squamous intraepithelial lesion (HSIL) histology or higher (P = 0.004). Of the 58 women in the see and treat group, 14 had no lesions (cervical intraepithelial neoplasia or cancer) on loop electrosurgical excision procedure histology, for an overtreatment rate of 24.1% on the basis of cytology alone. When stratified by colposcopic findings, the overtreatment rate was 61.1% in women who had low-grade lesions or lesser on colposcopy, which was significantly higher than that in women who had high-grade lesions (7.5%, P < 0.001). Multivariate analysis revealed that women with low-grade lesions or lesser on colposcopy had 18.25 times (95% confidence interval (CI) = 3.82-87.23, P < 0.001) greater risk of overtreatment after adjusting for age, parity, menopausal status, contraceptive methods and adequacy of colposcopy. Conclusion: Selective use of the see and treat approach in women with ASC-H smears who have high-grade lesions on colposcopy is feasible with an acceptable overtreatment rate. © 2009 Japan Society of Obstetrics and Gynecology.