Factors Related to Overtreatment in the See-and-Treat Approach: A Retrospective Multicentric Observational Study. Issue 2 (April 2019)

• Record Type: Journal Article
• Authors: Ciavattini, Andrea; Morini, Stefano; Delli Carpini, Giovanni; Del Fabro, Anna; Serri, Matteo; Verdecchia, Valeria; Cigolot, Federica; Cadel, Manuela; Clemente, Nicolò; Sopracordevole, Francesco
• Is Part Of: Journal of lower genital tract disease. Volume 23:Issue 2(2019:Apr.)
• Publication Date: 2019-04
• Subjects: cervical cancer -- cervical intraepithelial neoplasia -- see and treat -- cervical cytology -- colposcopy -- cervical excision; Generative organs, Female -- Diseases -- Periodicals; Cervix uteri -- Diseases -- Periodicals; Generative organs -- Diseases -- Periodicals; Sexually transmitted diseases -- Periodicals; 618.1
• DOI: 10.1097/LGT.0000000000000455
• Languages: English
• ISSNs: 1089-2591

Abstract

Abstract : 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.