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

Autor: Ruud L.M. Bekkers, Remko P. Bosgraaf, H. W. van der Pluijm-Schouten, P. A. J. van den Akker, Renée M.F. Ebisch, Willem J. G. Melchers, Maroeska M. Rovers, Leon F.A.G. Massuger
Rok vydání: 2015
Předmět:
Adult
medicine.medical_specialty
Variance method
Electrosurgery
medicine.medical_treatment
MEDLINE
Uterine Cervical Neoplasms
Cervix Uteri
Cochrane Library
Cervical intraepithelial neoplasia
03 medical and health sciences
0302 clinical medicine
medicine
Humans
In patient
Referral and Consultation
Aged
Gynecology
Colposcopy
Vaginal Smears
030219 obstetrics & reproductive medicine
Women's cancers Radboud Institute for Molecular Life Sciences [Radboudumc 17]
medicine.diagnostic_test
business.industry
Obstetrics
Incidence (epidemiology)
Incidence
Obstetrics and Gynecology
General Medicine
Middle Aged
medicine.disease
Uterine Cervical Dysplasia
Women's cancers Radboud Institute for Health Sciences [Radboudumc 17]
030220 oncology & carcinogenesis
See and treat
Meta-analysis
Urological cancers Radboud Institute for Health Sciences [Radboudumc 15]
Female
business
Zdroj: BJOG : an International Journal of Obstetrics and Gynaecology, 123, 59-66
BJOG : an International Journal of Obstetrics and Gynaecology, 123, 1, pp. 59-66
ISSN: 1471-0528
1470-0328
Popis: Contains fulltext : 152209.pdf (Publisher’s version ) (Closed access) 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.
Databáze: OpenAIRE
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