Background: To evaluate the feasibility of conization without a prior punch biopsy for patients with abnormal cytology. Methods: A retrospective review was performed for 700 patients who underwent conization at a single institution from January 2003 to August 2012. Each of these patients was assigned to one of two groups, either the ‘see-and-treat' group or the ‘three-step' group, depending on whether the patient had undergone a punch biopsy before conization or not. The final histologic results of two groups were compared. Results: The overtreatment risk was higher in the ‘see-and-treat' group in patients with atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (ASCUS/LSIL) cytology (64.7% in the ‘see-and-treat' group vs. 36.5% in the ‘three-step' group; p = 0.001). There was no significant statistical difference in the rate of cervical dysplasia or invasive carcinoma in patients with high-grade squamous intraepithelial lesion (HSIL) cytology between groups (91.8% in the ‘see-and-treat' group vs. 93.5% in the ‘three-step' group; p = 0.793). Conclusion: The patients with HSIL on cytology can be managed by a ‘see-and-treat' strategy with a low risk of overtreatment. On the other hand, the ‘three-step' management is more appropriate in patients with ASCUS/LSIL cytology.

Keywords:
Cervical intraepithelial neoplasia, Conization, HSIL, ASCUS/LSIL, ‘See-and-treat’ strategy
1.
Gupta S, Sodhani P, Halder K, Chachra K, Sardana S, Singh V, Sehgal A: Spectrum of epithelial cell abnormalities of uterine cervix in a cervical cancer screening programme: implications for resource limited settings. Eur J Obstet Gynecol Reprod Biol 2007;134:238-242.
2.
Papanicolaou G: A new procedure for staining vaginal smears. Science 1942;95:438-439.
3.
Emam M, Elnashar A, Shalan H, Barakat R: Evaluation of a single-step diagnosis and treatment of premalignant cervical lesion by LEEP. Int J Gynaecol Obstet 2009;107:224-227.
4.
Keijser K, Kenemans P, van den Zanden P, Schijf C, Vooijs G, Rolland R: Diathermy loop excision in the management of cervical intraepithelial neoplasia: diagnosis and treatment in one procedure. Am J Obstet Gynecol 1992;166:1281-1287.
5.
Siegler E, Bornstein J: Loop electrosurgical excision procedures in Israel. Gynecol Obstet Invest 2011;72:85-89.
6.
Li Z, Qian de Y, Cen J, Chen G, Shu Y: Three-step versus ‘see-and-treat' approach in women with high-grade squamous intraepithelial lesions in a low-resource country. Int J Gynaecol Obstet 2009;106:202-205.
7.
Sjoborg K, Vistad I, Myhr S, Svenningsen R, Herzog C, Kloster-Jensen A, Nygard G, Hole S, Tanbo T: Pregnancy outcome after cervical cone excision: a case-control study. Acta Obstet Gynecol Scand 2007;86:423-428.
8.
Kyrgiou M, Koliopoulos G, Martin-Hirsch P, Arbyn M, Prendiville W, Paraskevaidis E: Obstetric outcomes after conservative treatment for intraepithelial or early invasive cervical lesions: systematic review and meta-analysis. Lancet 2006;367:489-498.
9.
Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L: Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 2004;291:2100-2106.
10.
Nogara P, Manfroni L, da Silva M, Consolaro M: The ‘see-and-treat' strategy for identifying cytologic high-grade precancerous cervical lesions among low-income Brazilian women. Int J Gynaecol Obstet 2012;118:103-106.
11.
Solomon D, Davey D, Kurman R, Moriarty A, O'Connor D, Prey M, Raab S, Sherman M, Wilbur D, Wright T Jr, Young N: The 2001 Bethesda System: terminology for reporting results of cervical cytology. JAMA 2002;287:2114-2119.
12.
Papoutsis D, Rodolakis A, Mesogitis S, Sotiropoulou M, Antsaklis A: Appropriate cone dimensions to achieve negative excision margins after large loop excision of transformation zone in the uterine cervix for cervical intraepithelial neoplasia. Gynecol Obstet Invest 2013;75:163-168.
13.
Kupets R, Paszat L: How are women with high-grade Pap smear abnormalities managed? A population-based study. Gynecol Oncol 2011;121:499-504.
14.
ASCUS-LSIL Traige Study (ALTS) Group: Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol 2003;188:1383-1392.
15.
Solomon D, Schiffman M, Tarone R: Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst 2001;93:293-299.
16.
Solomon D, Schiffman M, Tarone R: ASCUS LSIL Triage Study (ALTS) conclusions reaffirmed: response to a November 2001 commentary. Obstet Gynecol 2002;99:671-674.
17.
Fremont-Smith M, Marino J, Griffin B, Spencer L, Bolick D: Comparison of the SurePath liquid-based Papanicolaou smear with the conventional Papanicolaou smear in a multisite direct-to-vial study. Cancer 2004;102:269-279.
18.
TOMBOLA Group: Biopsy and selective recall compared with immediate large loop excision in management of women with low-grade abnormal cervical cytology referred for colposcopy: multicentre randomised controlled trial. BMJ 2009;339:b2548.
19.
Szurkus D, Harrison T: Loop excision for high-grade squamous intraepithelial lesion on cytology: correlation with colposcopic and histologic findings. Am J Obstet Gynecol 2003;188:1180-1182.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.