Highlights
- •The screen-and-treat approach aims to reduce the losses ascribed to follow-up.
- •No difference was observed in the LLETZ diagnosis in terms of who used this approach.
- •Negative colposcopic findings are more often associated with overtreatment.
Abstract
Objective
To detect factors related to overtreatment with the “Screen-and-treat” approach (S&T)
in women with suspicious cervical precancerous lesions.
Study design
A retrospective observational study of 524 women with high-grade squamous intraepithelial
lesions (HSIL) or more severe (HSIL+) in cytology, treated by the Large Loop Excision
of the Transformation Zone (LLETZ): 161 without a previous biopsy (S&T group) and
363 with a previous biopsy (biopsy group) from January 2017 to July 2020. The main
outcome was a diagnosis of LLETZ: negative (negative or low-grade squamous intraepithlelial
lesion LSIL) or HSIL+. A negative diagnosis was interpreted as “overtreatment.” Results
were analyzed as a function of the S&T approach (whether previous biopsy or not).
Variables were obtained from medical records, and were compared with Chi-square or
Fisher's exact test (p, p-value), to estimate the chances of a logistic regression
analysis (Odds Ratio, OR, or admitting a Confidence Interval (CI) of 95 %).
Results
No differences were observed in groups regarding menopausal status, smoking, hormonal
contraceptive use, colposcopy findings, LLETZ diagnosis, and recurrence. Comparing
biopsy vs S&T groups, the frequency of women over 40 years was 28.4 % vs 39.7 % (p = 0.011),
and transformation zone type 3 was 12.2 vs 26.8 % (p < 0.001), respectively. In women
managed by S&T, when compared to a LLETZ diagnosis, an HSIL+ result was more frequent
in women presenting with TZ 1 (93.1 % TZ1 vs 78.5 % TZ2 vs 73.8 % TZ3, p = 0.008)
and in women with abnormal colposcopy (92.9 % abnormal vs 38.1 % negative, p < 0.001).
Multiple regression analysis found that women with negative colposcopic findings presented
a higher risk for negative LLETZ diagnosis (LSIL/Negative final histology) (18.6;
6.18–56.02).
Conclusions
No difference was observed in the LLETZ diagnosis in women who did or did not use
the S&T approach: it was adequate for women referred by cytological HSIL along with
high-grade colposcopic findings.
Keywords
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Article info
Publication history
Published online: November 21, 2022
Accepted:
November 18,
2022
Received in revised form:
November 2,
2022
Received:
September 22,
2022
Footnotes
☆The project was approved by the "Ethics and Research Committee" of the University of Campinas, under the number CAAE 13034013.6.0000.5404 version 3, on September 24, 2018.
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
