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See‐and‐treat management of high‐grade squamous intraepithelial lesions in a resource‐constrained African setting
Author(s) -
Chigbu Chibuike O.,
Onyebuchi Azubuike K.
Publication year - 2014
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.2013.07.040
Subject(s) - medicine , intensive care medicine
Objective To compare the treatment outcomes of women with high‐grade squamous intraepithelial lesions (HSIL) who underwent immediate loop electrosurgical excision procedure (LEEP) and those who had directed biopsies prior to subsequent LEEP. Methods Women who were referred for HSIL to 2 centers in southeast Nigeria were examined via colposcopy. Those with positive colposcopic findings were randomized to receive either immediate LEEP (see‐and‐treat group) or directed biopsies (3‐step group). Women with directed biopsy‐confirmed results underwent follow‐up LEEP. Overtreatment rate, cost, default rate, and cytology–treatment interval were compared between the 2 groups. Results In total, 314 women were included in the study. The overtreatment rate was similar between the groups. Treatment cost and cytology–treatment interval were significantly higher in the 3‐step group ( P = 0.0001). The default rate was significantly lower in the see‐and‐treat group ( P = 0.0001). Most (219 [69.7%]) participants preferred the see‐and‐treat approach. Conclusion Immediate see‐and‐treat LEEP for women with HSIL in southeast Nigeria is cheaper, less time‐consuming, and associated with better patient compliance than the 3‐step management procedure. Furthermore, it does not lead to significantly higher overtreatment. The immediate see‐and‐treat approach may be ideal for the management of women with HSIL in low‐resource countries.