The "see and treat" strategy for identifying cytologic high-grade precancerous cervical lesions among low-income Brazilian women.

OBJECTIVE

To evaluate the strategy of "see and treat" by loop electrosurgical excision procedure (LEEP) for cytologic high-grade precancerous cervical lesions (squamous intraepithelial lesions; HSIL) and post-LEEP recurrence among low-income Brazilian women.

METHODS

In a retrospective survey of women who underwent LEEP for cytologic HSIL without prior cervical biopsy between January 2004 and March 2008 at CISVALI, União da Vitória, Paraná, Brazil, LEEP sample histology and patient follow-up by Papanicolaou smear were assessed.

RESULTS

Among 117 women treated, 24% had no lesions, 67.5% had cervical intraepithelial neoplasia (CIN) grade 2/3, and 5.2% had squamous cell carcinoma or adenocarcinoma on LEEP histology. Among patients with follow-up, recurrences occurred in those with no lesions (16.7%) and CIN 2/3 (25%) (P>0.05). HSIL was the most frequent type of recurrence (87%) (P<0.001). In total, 6.3% of patients had positive ectocervical (ecto-positive) and endocervical (endo-positive) margins, 3.8% had ecto-positive, and 33.0% had endo-positive margins. Recurrences occurred in women with endo-positive (26.3%), no margin (17.4%), and cautery artifact margin (25.0%) involvement (P>0.05).

CONCLUSION

For cytologic HSIL, the benefits of the strategy of "see and treat" by LEEP outweighed the risk of overtreatment. Patients with both positive and negative margins on LEEP should be followed carefully.