Departamento de Ginecologia, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Rev Saude Publica. 2009 Oct;43(5):846-50. doi: 10.1590/s0034-89102009000500014.
To compare the effectiveness between the see-and-treat (S&T) approach and the conventional one (with prior biopsy) for squamous intraepithelial lesions of uterine cervix.
A cross-sectional study was conducted with 900 nonpregnant women with cytology suggestive of high grade squamous intraepithelial lesions in the city of Rio de Janeiro, Southeastern Brazil, between 1998 and 2004. The S&T approach consists of a large loop excision of the transformation zone procedure and is recommended when cytology is suggestive of high grade squamous intraepithelial lesion, satisfactory colposcopy with abnormalities compatible with the suspected cytological results, and the lesion is limited to the ectocervix or extends up to one centimeter of the endocervical canal. A subgroup of 336 patients whose colposcopy was considered satisfactory was analyzed, and they were divided into two groups for comparison: patients treated without prior biopsy (n = 288) and patients treated after a biopsy showing high grade squamous intraepithelial lesions (n = 48). Patients who were not treated or only treated more than a year later after recruitment at the colposcopy unit were considered dropouts.
Of patients recruited during the study period, 71 were not treated or were only treated for at least a year. The overall dropout rate was 7.9% (95% CI: 6.1;9.7). Mean time elapsed between patient recruitment and treatment was 17.5 days in the S&T group and 102.5 days in the prior biopsy group. Dropout rates were 1.4% (95% CI: 0.04;2.7) and 5.% (95% CI: 0;12.3), respectively (p=0.07). The proportion of overtreated cases (negative histology) in the S&T group was 2.0% (95% CI: 0.4;3.6).
The difference in the mean time elapsed between patient recruitment and treatment indicates that S&T is a time-saving approach The proportion of negative cases from using the S&T approach can be regarded as low.
比较宫颈上皮内瘤样病变的观察-治疗（S&T）方法与传统方法（先行活检）的疗效。
本研究为巴西东南部城市里约热内卢的一项横断性研究，于 1998 年至 2004 年期间共纳入 900 例细胞学检查提示高级别鳞状上皮内病变的非妊娠妇女。S&T 方法包括转化区大圈切除术，当细胞学检查提示高级别鳞状上皮内病变、阴道镜检查满意且异常符合可疑细胞学结果、病变局限于宫颈外口或延伸至宫颈内口 1cm 以内时，推荐使用该方法。对阴道镜检查满意的 336 例患者进行了亚组分析，并将其分为两组进行比较：未经活检直接治疗组（n=288）和先行活检显示高级别鳞状上皮内病变后治疗组（n=48）。招募至阴道镜检查单元后未治疗或治疗时间超过 1 年的患者被视为脱落病例。
在研究期间纳入的患者中，有 71 例未治疗或仅治疗了 1 年以上。总的脱落率为 7.9%（95%CI：6.1%；9.7%）。S&T 组患者从招募到治疗的平均时间为 17.5 天，而先行活检组为 102.5 天。两组的脱落率分别为 1.4%（95%CI：0.04%；2.7%）和 5.0%（95%CI：0%；12.3%）（p=0.07）。S&T 组过度治疗（阴性组织学）的病例比例为 2.0%（95%CI：0.4%；3.6%）。
S&T 方法可显著缩短从招募到治疗的时间间隔。S&T 方法的阴性病例比例可视为较低。
