Effect of Immediate Loop Electrode Excisional Procedure for High-Grade Cervical Cytology in an Urban Academic Clinic Setting

• Published in: Journal of lower genital tract disease Vol. 22; no. 4; p. 311
• Main Authors: McGregor, Ali E, Gecsi, Kimberly
• Format: Journal Article
• Language: English
• Published: United States 01.10.2018
• Subjects: Adult; Aged; Aged, 80 and over; Cervical Intraepithelial Neoplasia - diagnosis; Cervical Intraepithelial Neoplasia - surgery; Disease Management; Electrosurgery - methods; Female; Humans; Medical Overuse; Middle Aged; Papanicolaou Test; Retrospective Studies; Squamous Intraepithelial Lesions of the Cervix - diagnosis; Squamous Intraepithelial Lesions of the Cervix - surgery; Treatment Outcome; Urban Population
• ISSN: 1526-0976
• DOI: 10.1097/LGT.0000000000000426

The aim of the study was to determine whether treating all patients older than 25 years with high-grade squamous intraepithelial lesion (HSIL) Paps with immediate loop electrode excisional procedure (LEEP) improves rates of receiving indicated treatment and evaluating whether this practice results in overtreatment (defined by excisional pathology less than cervical intraepithelial neoplasia 2). This was a retrospective cohort study at an urban, Medicaid-based clinic, which evaluated women older than 25 years with HSIL Pap results seen from June 2011 to December 2016. In June 2013, the clinic practice was restructured and management of HSIL Pap results in patients older than 25 years was standardized to immediate LEEP procedure, without intermediate colposcopic examination. Our primary outcome is the number of women who received LEEPs before and after this clinical practice change. The secondary outcome evaluated the number of women who received overtreatment. The χ test with a p value of 0.05 as significant was used to compare the results between groups. Twenty-three (82%) of the 28 women treated before clinical practice change received indicated treatment, with 19 receiving LEEPs. Twenty-four (96%) of the 25 women treated after the clinical practice change received indicated LEEPs (p = .11). Seven (37%) of the 19 women in the initial group had LEEP pathology results less than CIN 2, whereas only 4 (17%) of the 24 women in the immediate LEEP group had results less than CIN 2 (p = .13). Implementation of a standardized management of HSIL Pap with immediate LEEP did not statistically increase the amount of patients who received indicated LEEPs; however, implementation of this practice did not result in overtreatment.