Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis.

Autor:	Ebisch, RMF, Rovers, MM, Bosgraaf, RP, Pluijm‐Schouten, HW, Melchers, WJG, Akker, PAJ, Massuger, LFAG, Bekkers, RLM
Předmět:	TREATMENT of cervical intraepithelial neoplasia DISEASE management META-analysis SYSTEMATIC reviews OVERTREATMENT of cancer HISTOLOGY COLPOSCOPY SUBGROUP analysis (Experimental design) CERVIX uteri ELECTROSURGERY MEDICAL referrals PAP test CERVIX uteri tumors DISEASE incidence CERVICAL intraepithelial neoplasia
Zdroj:	BJOG: An International Journal of Obstetrics & Gynaecology; Jan2016, Vol. 123 Issue 1, p59-66, 8p
Abstrakt:	Background: Studies of see-and-treat management of cervical intraepithelial neoplasia (CIN) vary in their inclusion criteria, resulting in a broad range of overtreatment rates.Objectives: To determine overtreatment rates in see-and-treat management of women referred for colposcopy because of suspected CIN, in order to define circumstances supporting see-and-treat management.Search Strategy: MEDLINE, EMBASE, and the Cochrane Library were searched from inception up to 12 May 2014.Selection Criteria: Studies of see-and-treat management in women with a reported cervical smear result, colposcopic impression, and histology result were included.Data Collection and Analysis: Methodological quality was assessed with the Newcastle-Ottawa scale. We used the inverse variance method for pooling incidences, and a random-effects model was used to account for heterogeneity between studies. Overtreatment was defined as treatment in patients with no CIN or CIN1.Main Results: Thirteen studies (n = 4611) were included. The overall overtreatment rate in women with a high-grade cervical smear and a high-grade colposcopic impression was 11.6% (95% CI 7.8-15.3%). The overtreatment rate in women with a high-grade cervical smear and low-grade colposcopic impression was 29.3% (95% CI 16.7-41.9%), and in the case of a low-grade smear and high-grade colposcopic impression it was 46.4% (95% CI 15.7-77.1%). In women with a low-grade smear and low-grade colposcopic impression, the overtreatment rate was 72.9% (95% CI 68.1-77.7%).Author's Conclusions: The pooled overtreatment rate in women with a high-grade smear and high-grade colposcopic impression is at least comparable with the two-step procedure, which supports the use of see-and-treat management in this subgroup of women.Tweetable Abstract: See-and-treat management is justified in the case of a high-grade smear and a high-grade colposcopic impression. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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