R M F Ebisch1, M M Rovers2,3, R P Bosgraaf1,4, H W van der Pluijm-Schouten1, W J G Melchers5, P A J van den Akker1, L F A G Massuger1, R L M Bekkers1. 1. Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, the Netherlands. 2. Department of Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands. 3. Department of Operating Rooms, Radboud University Medical Center, Nijmegen, the Netherlands. 4. Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands. 5. Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Abstract
BACKGROUND: Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates. OBJECTIVES: To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting see-and-treat management. SEARCH STRATEGY: MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12 May 2014. SELECTION CRITERIA: Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1. MAIN RESULTS: Thirteen studies (n = 4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95% CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95% CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95% CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95% CI 68.1-77.7%). AUTHOR'S CONCLUSIONS: The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women. TWEETABLE ABSTRACT: See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression.
BACKGROUND: Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates. OBJECTIVES: To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting see-and-treat management. SEARCH STRATEGY: MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12 May 2014. SELECTION CRITERIA: Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1. MAIN RESULTS: Thirteen studies (n = 4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95% CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95% CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95% CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95% CI 68.1-77.7%). AUTHOR'S CONCLUSIONS: The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women. TWEETABLE ABSTRACT: See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression.
Authors: Menelaos Tzafetas; Anita Mitra; Maria Paraskevaidi; Zsolt Bodai; Ilkka Kalliala; Sarah Bowden; Konstantinos Lathouras; Francesca Rosini; Marcell Szasz; Adele Savage; Julia Balog; James McKenzie; Deirdre Lyons; Phillip Bennett; David MacIntyre; Sadaf Ghaem-Maghami; Zoltan Takats; Maria Kyrgiou Journal: Proc Natl Acad Sci U S A Date: 2020-03-16 Impact factor: 11.205
Authors: Phuong Lien Tran; Bruno Kenfack; Eveline Tincho Foguem; Manuela Viviano; Liliane Temogne; Pierre-Marie Tebeu; Rosa Catarino; Anne-Caroline Benski; Pierre Vassilakos; Patrick Petignat Journal: Int J Womens Health Date: 2017-12-01
Authors: Rhafaela L Causin; Luciane S da Silva; Adriane F Evangelista; Letícia F Leal; Karen C B Souza; Danielle Pessôa-Pereira; Graziela M Matsushita; Rui M Reis; José H T G Fregnani; Márcia M C Marques Journal: Biomed Res Int Date: 2021-04-13 Impact factor: 3.411
Authors: Stephanie S Liu; Karen K L Chan; Tina N Wei; Ka Yu Tse; Siew F Ngu; Mandy M Y Chu; Lesley S K Lau; Annie N Y Cheung; Hextan Y S Ngan Journal: PLoS One Date: 2022-08-05 Impact factor: 3.752
Authors: Clare A Aitken; Albert G Siebers; Suzette M Matthijsse; Erik E L Jansen; Ruud L M Bekkers; Jeroen H Becker; Bram Ter Harmsel; Jan-Paul W R Roovers; Folkert J van Kemenade; Inge M C M de Kok Journal: Acta Obstet Gynecol Scand Date: 2019-02-27 Impact factor: 3.636
Authors: Renata Pereira Teodoro; Danielle Scherer; Maria José de Camargo; Ana Carolina Carioca da Costa; Cecília Vianna de Andrade; Fábio Russomano Journal: BMC Womens Health Date: 2021-12-07 Impact factor: 2.809