Kietpeerakool Chumnan, Srisomboon Jatupol, Khunamornpong Surapan, Siriaunkgul Sumalee, Sukkawattananon Wiratchanee
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Asian Pac J Cancer Prev. 2007 Apr-Jun;8(2):206-8.
The aim of this study was to determine the incidence and predictors of overtreatment in "see and treat" approach using loop electrosurgical excision procedure (LEEP) in women with high-grade squamous intraepithelial lesion (HSIL) on cervical cytology. The overtreatment was considered when LEEP specimens contained no cervical pathology. Between January 2001 and April 2006, 446 women with HSIL on Pap smear underwent colposcopy followed by LEEP at Chiang Mai University Hospital. Mean age of these patients was 45.6 years with a range of 25-78 years. One hundred and twenty-one (27.1%) women were menopausal. Unsatisfactory colposcopy was observed in 357 (80.0%) women. Of 446 women, histologically-confirmed HSIL, invasive cancer, low-grade squamous intraepithelial lesions, and adenocarcinoma in situ were detected in 330 (74.0%), 76 (17.0%), 9 (2.0%), and 5 (1.1%), respectively. The overtreatment rate on LEEP specimens was noted in 26 women or 5.8% (95% confidence interval [CI] = 3.8 to 8.4) of 446 women. By multivariate analysis, postmenopausal status was the only significant independent predictor of overtreatment with an adjusted odds ratio of 2.89 (95% CI = 1.30 to 6.43, P = 0.009). When postmenopausal women were excluded from analysis, the overtreatment rate was reduced to only 4.0%. In conclusion, "see and treat" approach appears to be an appropriate strategy in managing women with HSIL cytology. The overtreatment rate could be reduced when such policy is limited for premenopausal women.
本研究的目的是确定在宫颈细胞学检查为高级别鳞状上皮内病变（HSIL）的女性中，采用环形电切术（LEEP）“即看即治”方法时过度治疗的发生率及预测因素。当LEEP标本中未发现宫颈病变时，则视为过度治疗。2001年1月至2006年4月，446例巴氏涂片检查为HSIL的女性在清迈大学医院接受了阴道镜检查，随后进行了LEEP。这些患者的平均年龄为45.6岁，年龄范围为25至78岁。121名（27.1%）女性处于绝经后状态。357名（80.0%）女性的阴道镜检查结果不满意。在446名女性中，组织学确诊的HSIL、浸润癌、低级别鳞状上皮内病变和原位腺癌分别有330例（74.0%）、76例（17.0%）、9例（2.0%）和5例（1.1%）。在446名女性中，有26名女性的LEEP标本出现过度治疗，发生率为5.8%（95%置信区间[CI]=3.8至8.4）。多因素分析显示，绝经后状态是过度治疗的唯一显著独立预测因素，调整后的优势比为2.89（95%CI=1.30至6.43，P=0.009）。当将绝经后女性排除在分析之外时，过度治疗率仅降至4.0%。总之，“即看即治”方法似乎是管理HSIL细胞学女性的一种合适策略。当该策略仅限于绝经前女性时，过度治疗率可能会降低。
