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The “see and treat” strategy for identifying cytologic high‐grade precancerous cervical lesions among low‐income Brazilian women
Author(s) -
Nogara Paula R.B.,
Manfroni Luís A.R.,
da Silva Mariana C.,
Consolaro Marcia E.L.
Publication year - 2012
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2012.02.017
Subject(s) - medicine , low income , cytology , gynecology , obstetrics , pathology , socioeconomics , sociology
Objective To evaluate the strategy of “see and treat” by loop electrosurgical excision procedure (LEEP) for cytologic high‐grade precancerous cervical lesions (squamous intraepithelial lesions; HSIL) and post‐LEEP recurrence among low‐income Brazilian women. Methods In a retrospective survey of women who underwent LEEP for cytologic HSIL without prior cervical biopsy between January 2004 and March 2008 at CISVALI, União da Vitória, Paraná, Brazil, LEEP sample histology and patient follow‐up by Papanicolaou smear were assessed. Results Among 117 women treated, 24% had no lesions, 67.5% had cervical intraepithelial neoplasia (CIN) grade 2/3, and 5.2% had squamous cell carcinoma or adenocarcinoma on LEEP histology. Among patients with follow‐up, recurrences occurred in those with no lesions (16.7%) and CIN 2/3 (25%) ( P > 0.05). HSIL was the most frequent type of recurrence (87%) ( P < 0.001). In total, 6.3% of patients had positive ectocervical (ecto‐positive) and endocervical (endo‐positive) margins, 3.8% had ecto‐positive, and 33.0% had endo‐positive margins. Recurrences occurred in women with endo‐positive (26.3%), no margin (17.4%), and cautery artifact margin (25.0%) involvement ( P > 0.05). Conclusion For cytologic HSIL, the benefits of the strategy of “see and treat” by LEEP outweighed the risk of overtreatment. Patients with both positive and negative margins on LEEP should be followed carefully.