The overtreatment rate, medical cost and psychological affection of see-and-treat versus three-step approaches in the treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis.

OBJECTIVES

The see-and-treat (S&T) approach is increasingly utilized for the treatment of cervical intraepithelial neoplasia (CIN). However, its recognition remains limited compared to the traditional three-step management. This study aims to systematically review and compare the outcomes of studies that directly assess the S&T and three-step approaches in CIN treatment.

METHODS

A comprehensive literature search was conducted in MEDLINE, EMBASE, and the Cochrane Library up to December 10, 2024. Eligible studies directly compared the overtreatment rate, medical costs, and psychological impact of the S&T and three-step approaches for abnormal cervical smears. The inclusion criteria for women undergoing S&T had to align with those for three-step management. Data on overtreatment risk, medical costs, and psychological effects were extracted and analyzed. Comparative results were presented using forest plots, stratified by different smear categories.

RESULTS

Twelve publications were included, comprising three randomized controlled trials (RCTs) and nine observational studies. Among women with ASC-H or HSIL, the overtreatment risk following S&T was comparable to that of the three-step approach (ASC-H, RR 1.40, 95% CI 0.75-2.60; HSIL, RR 0.93, 95% CI 0.71-1.23). However, in the LSIL/AS-CUS subgroup, the S&T approach was associated with a significantly higher overtreatment risk compared to the three-step method (RR 2.03, 95% CI 1.92-2.15). The S&T approach was associated with lower medical expenses for HSIL cases and a reduction in patients' negative emotional responses compared to the three-step procedure.

CONCLUSIONS

The S&T approach may be a suitable alternative for women with HSIL/ASC-H smear results, considering its comparable overtreatment risk, potential cost savings, and psychological benefits. However, its use in LSIL/ASC-US cases should be carefully evaluated due to the increased risk of overtreatment.