Meirovitz Mihai, Gatt Dvir, Dreiher Jacob, Shaco-Levy Ruthy
Isr Med Assoc J. 2014 May;16(5):303-6.
The "see and treat" approach, proceeding without a biopsy directly to uterine cervix conization in women diagnosed with high grade squamous intraepithelial lesion (HGSIL) on Pap smear, shortens the treatment duration, lessens patient anxiety, and reduces health care costs.
To evaluate the level of diagnostic accuracy and the over-treatment rate in the "see and treat" versus conventional management of women diagnosed with HGSIL.
We retrospectively reviewed all women with HGSIL who had undergone the "see and treat" approach during 2001-2011 at Soroka University Medical Center. Similar cohorts, who were managed conventionally with a cervical biopsy prior to the conization, served as a comparison group.
The study population consisted of 403 women: 72 (18%) had undergone the "see and treat" approach and 331 (82%) conventional management. The false positive rate was 11% for the "see and treat" group, compared to 6% for the conventional management group (P = 0.162). Similarly, no statistically significant difference was observed when comparing the positive predictive value (PPV) of high grade dysplasia diagnosed on Pap smear (PPV 88.9%) versus cervical biopsy (PPV 93.8%) (P = 0.204). Moreover, both the false positive rate and PPV remained similar in subgroups of patients, according to age, menopausal status, number of births, and colposcopy findings.
The accuracy level of HGSIL diagnosis on Pap smear is similar to that of high grade dysplasia on a cervical biopsy. We therefore recommend referring patients with HGSIL directly to conization. Skipping the biopsy step was not associated with significant over-treatment or other adverse effects.
“即诊即治”方法是指在巴氏涂片检查诊断为高级别鳞状上皮内病变（HGSIL）的女性中，不进行活检直接进行子宫颈锥切术，该方法缩短了治疗时间，减轻了患者焦虑，并降低了医疗成本。
评估“即诊即治”与传统管理方式在诊断为HGSIL的女性中的诊断准确性水平和过度治疗率。
我们回顾性分析了2001年至2011年期间在索罗卡大学医学中心接受“即诊即治”方法的所有HGSIL女性患者。将在锥切术前常规进行宫颈活检的类似队列作为对照组。
研究人群包括403名女性：72名（18%）接受了“即诊即治”方法，331名（82%）接受了传统管理。“即诊即治”组的假阳性率为11%，而传统管理组为6%（P = 0.162）。同样，比较巴氏涂片诊断的高级别发育异常的阳性预测值（PPV 88.9%）与宫颈活检的阳性预测值（PPV 93.8%）时，未观察到统计学上的显著差异（P = 0.204）。此外，根据年龄、绝经状态、分娩次数和阴道镜检查结果，患者亚组中的假阳性率和PPV保持相似。
巴氏涂片上HGSIL诊断的准确性水平与宫颈活检中高级别发育异常的准确性水平相似。因此，我们建议将HGSIL患者直接转诊至锥切术。跳过活检步骤与显著的过度治疗或其他不良反应无关。
