Screen-and-treat approach in managing cervical cancer precursor lesions: An observational study with 524 women

• Published in: European journal of obstetrics & gynecology and reproductive biology Vol. 280; pp. 78 - 82
• Main Authors: Yoneda, Juliana Y., Teixeira, Julio C., Derchain, Sophie, Bragança, Joana F., Zeferino, Luiz C., Vale, Diama B.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.01.2023
• Subjects: Biopsy; Cervical Intraepithelial Neoplasia; Cervix Uteri - pathology; Colposcopy; Colposcopy - methods; Conization; Female; Humans; Pregnancy; Screen-and-treat; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Neoplasms; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Uterine Cervical Neoplasms; Conization; Colposcopy; Screen-and-treat; Cervical Intraepithelial Neoplasia
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2022.11.016

•The screen-and-treat approach aims to reduce the losses ascribed to follow-up.•No difference was observed in the LLETZ diagnosis in terms of who used this approach.•Negative colposcopic findings are more often associated with overtreatment. To detect factors related to overtreatment with the “Screen-and-treat” approach (S&T) in women with suspicious cervical precancerous lesions. A retrospective observational study of 524 women with high-grade squamous intraepithelial lesions (HSIL) or more severe (HSIL+) in cytology, treated by the Large Loop Excision of the Transformation Zone (LLETZ): 161 without a previous biopsy (S&T group) and 363 with a previous biopsy (biopsy group) from January 2017 to July 2020. The main outcome was a diagnosis of LLETZ: negative (negative or low-grade squamous intraepithlelial lesion LSIL) or HSIL+. A negative diagnosis was interpreted as “overtreatment.” Results were analyzed as a function of the S&T approach (whether previous biopsy or not). Variables were obtained from medical records, and were compared with Chi-square or Fisher's exact test (p, p-value), to estimate the chances of a logistic regression analysis (Odds Ratio, OR, or admitting a Confidence Interval (CI) of 95 %). No differences were observed in groups regarding menopausal status, smoking, hormonal contraceptive use, colposcopy findings, LLETZ diagnosis, and recurrence. Comparing biopsy vs S&T groups, the frequency of women over 40 years was 28.4 % vs 39.7 % (p = 0.011), and transformation zone type 3 was 12.2 vs 26.8 % (p < 0.001), respectively. In women managed by S&T, when compared to a LLETZ diagnosis, an HSIL+ result was more frequent in women presenting with TZ 1 (93.1 % TZ1 vs 78.5 % TZ2 vs 73.8 % TZ3, p = 0.008) and in women with abnormal colposcopy (92.9 % abnormal vs 38.1 % negative, p < 0.001). Multiple regression analysis found that women with negative colposcopic findings presented a higher risk for negative LLETZ diagnosis (LSIL/Negative final histology) (18.6; 6.18–56.02). No difference was observed in the LLETZ diagnosis in women who did or did not use the S&T approach: it was adequate for women referred by cytological HSIL along with high-grade colposcopic findings.