Clinical Application Of “See And Treat” Strategy For Diagnosis And Treatment Of Cervical Lesions

Background:Recent research shows that the incidence of cervical cancer is increasing year by year,and the onset age is becoming younger.It is the issue of extensive concern to standardize screening cervical cancer for early intervention in the gynecologic field.The traditional three-step technique which is referred to cytologic examination?colposcopically directed cervical biopsy?LEEP,is recognized as an effective primary management of the screening of cervical cancer.It plays an important role in the prevention and treatment of cervical precancerous lesions and cervical cancer.With the widespread use of colposcopy,there is a great debate in the management of screening cervical lesions,that whether it is a necessary step for those patients who have visible lesions to have colposcopically directed cervical biopsy.Those scholars who recommend the “see and treat”strategy hold the reason that the accuracy rate of colposcopically directed cervical biopsy is not much higher,the direct line loop electrosurgical excisional procedure(LEEP)diagnostic conization surgery is more superior.However,some scholars believe that the two methods are similar,and the latter may have higher overtreatment rate.Objective:To evaluate the effectiveness between patients with cervical lesions who have undergone LEEP with and without prior colposcopically directed biopsy.Methods:Choose those women who went to Yijishan Hospital of Wannan Medical College from October 2015 to October 2016,all cases accept the TCT and HR-HPV DNA check,the discovery of TCT shows abnormal(including ASCUS?ASC-H?LSIL?HSIL)and/or HR-HPV positive taken to colposcopy check and scored according to the Reid's colposcopic index(RCI),those patients with HSIL or LSIL were selected as the subject of this study and divided into two groups(HSIL and LSIL).Each group were randomly divided into two teams,one treated by traditional three-step technique(TT),while the another were treated by “see and treat”strategy(ST).The final histological diagnosis of "see and treat" teams is based on the LEEP results.For the traditional three-step team,if the result of colposcopically directed cervical biopsy is not as the same as that of LEEP,the higher pathological grade is the final histological diagnosis.Compare the results of the two methods,and analyze the clinical application value of "see and treat" strategy.Results:1.There were 257 subjects selected in the study,159 cases in the group HSIL:there were 84 cases in team TT(besides them there were 9 cases lost visit),66 cases in team ST.98 cases in the group HSIL:there were 45 cases in team TT(besides them there were 4 cases lost visit),49 cases in team ST.2.There were 129 cases underwent the traditional three-step technique(besides them there were 13 cases lost visit),compare the results of colposcopically directed cervical biopsy and LEEP surgery,the consistency of the two diagnostic methods exists,but not satisfactory(Kappa=0.325).The diagnostic accordance rate of the colposcopically directed cervical biopsy and the final result was 93.8%,and the rate of missed diagnosis was 7.2%.3.In Group HSIL,the results of the two methods were the same in 50 cases,the pathological grade increased in 18 cases,and 16 cases decreased.In Group LSIL,the results of the two methods were the same in 19 cases,the pathological grade increased in 6 cases,and 20 cases decreased.4.The final histological diagnosis of team TT in Group HSIL was:the rate of high-grade lesions was 85.7%,invasive cervical cancer was 4.8%,overtreatment rate was 9.5%;While the histological diagnosis of team ST was:the rate of high-grade lesions was 81.8%,invasive cervical cancer was 4.5%,overtreatment rate was 13.6%.The difference between the two teams was not statistically significant(P>0.05),and the difference of overtreatment rate was not statistically significant(P>0.05).The final histological diagnosis of team TT in Group LSIL was:the rate of high-grade lesions was 73.3%,invasive cervical cancer was 4.4%,overtreatment rate was 22.2%;While the histological diagnosis of team ST was:the rate of high-grade lesions was 38.8%,invasive cervical cancer was 4.1%,overtreatment rate was 57.1%.The difference between the two teams was statistically significant(P<0.05),and the difference of overtreatment rate was statistically significant(P<0.05),team ST was significantly lower than team TT.5.In this study,either in the HSIL group or the LSIL group,the average age and the RCI scores were not statistically different in both team TT and ST(P>0.05),the visits and costs between the two teams were statistically different(P<0.05),the former was significantly higher than the latter.There was 9.7% miss rate in team TT of the HSIL group,and 8.2% of the LSIL group,and 0 in team ST of both groups.Conclusin:1.LEEP surgery is an effective method of treatment of cervical lesions,the "see and treat" strategy for those patients underwent HSIL is suitable,the overtreatment rate was not significantly different with traditional three-step technique.2.There was a certain miss rate of the traditional three-step technique,the "see and treat" strategy can significantly reduce the patients' s vists and costs,and save medical resources,especially suitable for those patients who were in poor economic conditions and low follow-up intention.