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A “See and Treat” Approach for High Grade Squamous Intraepithelial Lesion on Cervical Cytology


Kittipat Charoenkwan MD*, Jatupol Srisomboon MD*,
Sumalee Siriaunkgul MD**, Surapan Khunamornpong MD**,
Prapaporn Suprasert MD*, Chailert Phongnarisorn MD*,
Sitthicha Siriaree MD*, Chalong Cheewakriangkrai MD*

* Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University
** Department of Pathology, Faculty of Medicine, Chiang Mai University


Objective : To examine the final histologic findings as well as to correlate colposcopic and histologic findings in patients who had a high-grade squamous intraepithelial lesion (HGSIL) on the Pap smear and underwent colposcopy followed by LEEP on the “See and Treat” basis without intervening colposcopically directed biopsy.
Material and Method: The medical records of patients with HGSIL on cytology who underwent LEEP without prior cervical biopsy at Chiang Mai University Hospital over a 5-month period were reviewed. The authors summarized the final LEEP histologic results and correlated colposcopic and histologic findings in these patients.
Results : Of 55 patients who had a see-and-treat LEEP, 53 patients (96%) had a high-grade intraepithelial lesion or higher. There were 11 patients (20%) who had invasive squamous cell carcinoma. Of 4 patients with a low-grade lesion on colposcopic examination, all had a high-grade lesion or higher on final histology. Forty-four patients (96%) with high-grade impression on colposcopy had high-grade or more severe lesion on the final histologic diagnosis.
Conclusion : For patients with a high-grade lesion on the Pap smear, LEEP according to the “See and Treat” approach appeared to be a reasonable alternative to conventional colposcopically directed biopsy, especially in low resource settings.

Keyword : Cervical neoplasia, Colposcopy, High-grade squamous intraepithelial lesion, Large loop excision of the transformation zone, Loop electrosurgical excision procedure

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