Is the Loop Electrosurgical Excision Procedure Necessary for Minor Cervical Cytological Abnormalities?

  • Aksan-Desteli, Guldeniz ;
  • Gursu, Turkan ;
  • Baykal, Cem Murat
  • Published : 2014.01.15


Background: To investigate the indications of loop electrosurgical excision procedure (LEEP) and its overtreatment rates for the see and treat and three step strategies in cases of atypical squamous cells of undetermined cytology (ASC-US) and low grade intraepithelial neoplasia (LGSIL) cytology. Materials and Methods: We retrospectively analyzed colposcopy directed biopsy (CDB) and LEEP results of 176 paients with ASC-US or LGSIL cytologies who underwent colposcopic examination. Results: Initial cytologies were ASCUS in 120 women and LGSIL in 56. According to the see and treat approach immediate LEEP was performed for38 women. Among the remaining 138 women, LEEP was performed for 32 whose CDB results revealed CIN2/3 lesions. In the see and treat group the recognition of CIN2/3 was found to be 39.4%. The overtreatment rate was 60% as compared to 25% in the three step group. In CDB group detection of CIN 2 or greater lesions increased with 3 or more biopsies. Conclusions: In patients with ASC-US/LGSIL cytologies CDB should be performed before LEEP to prevent overtreatment, with attention to all suspected areas and more than 2 biopsies taken.




  1. Solomon D, Schiffman M, Tarone R (2001). ALTS Study group. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst, 93, 293-9.
  2. Pretorius RG, Belinson JL, Burchette RJ, et al (2011). Regardless of skill, performing more biopsies increases the sensitivity of colposcopy. J Low Genit Tract Dis, 15, 180-8.
  3. Sadan O, Yarden H, Schejter E, et al (2007). Treatment of high grade squamous intra-epithelial lesions: a “see-and-treat” versus three-step strategy. Eur J Obstet Gynecol Reprod Biol, 131, 73-5.
  4. Solomon D, Nayar R (2005) Bethesda System for Cervicovaginal Cytology: Definitions, Criteria and Explanatory Notes. Second edition. Rio de Janeiro: Revinter.
  5. Zhi Gang Li, De Ying, Jian Min Cen, et al (2009). Three-step versus “see-and-treat” approach in women with high-grade squamous intraepithelial lesions in a low-resource country. Int J Gynaecol Obstet, 106, 202-5.
  6. Globocan (2008). Estimated cancer incidence, mortality, prevelance and disability-adjusted life years (DALYs) worldwide in 2008, International Agency for Research on Cancer, WHO.
  7. Duesing N, Schwarz J, Choschzick M, et al (2012). Assessment of cervical intraepithelial neoplasia (CIN) with colposcopic biopsy and efficacy of loop electrosurgical excision procedure (LEEP). Arch Gynecol Obstet, 286, 1549-54.
  8. Ferlay J, Bray F, Pisani P (2000). Cancer incidence, mortality and prevelance woldwide, version 1.0. IARC Cancer Base No.5. Lyon:IARC Pres, 2001.
  9. Gage JC, Hanson VW, Abbey K, et al (2006). ASCUS LSIL Triage Study (ALTS) Group Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol, 108, 264-72.
  10. HanByoul Cho, Jae-Hoon Kim (2009). Treatment of the patients with abnormal cervical cytology: a “see-and-treat” versus three-step strategy. J Gynecol Oncol, 20, 164-8.
  11. Kyrgiou M, Koliopoulus G, Martin-Hirsch P, et al (2007). Management of minor cervical cytological abnormalities: A systematic review and a meta-analysis of the literature. Cancer Treatment Reviews, 33, 514-20.
  12. Luesley D, Leeson S (2010). Colposcopy and programme management guidelines fort he NHS Cervical screening programme, NHSCSP Publication, no. 20. Sheffield, UK:NHSCSP.
  13. Moss EL, Hadden P, Douce G, et al (2012). Is the colposcopically directed punch biopsy a reliable diagnostic test in women with minor cytological lesions? J Low Genit Tract Dis, 16, 421-6.
  14. Nogara PR, Manfroni LA, da Silva MC, Consolaro ME (2012). The “see and treat” strategy for identifying cytologic highgrade precancerous cervical lesions among low-income Brazilian women. Int J Gynaecol Obstet, 118, 103-6.
  15. Byrom J, Douce G, Jones PW, et al (2006). Should punch biopsies be used when high grade disease is suspected at initial colposcopic assessment :A prospective study. Int J Gynecol Cancer, 16, 253-6.
  16. ASCUS-LSIL Traige Study (ALTS) (2003). GroupResults of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol, 188, 1383-92.
  17. Aue-Aungkul A, Punyawatanasin S, Natprathan A, et al (2011)."See and treat" approach is appropriate in women with high-grade lesions on either cervical cytology or colposcopy. Asian Pac J Cancer Prev, 12, 1723-6.
  18. Cho HanByoul, Jae-Hoon Kim (2009). Treatment of the patients with abnormal cervical cytology: a “see-and-treat” versus three-step strategy. J Gynecol Oncol, 20, 164-8.

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