THE TREATMENT OF CERVICAL INTRAEPITHELIAL NEOPLASIA - WHEN COULD WE SEE AND LOOP

Objective: To determine the possible role of the selective 'see and lo op' approach with a loop electrosurgical excision procedure (LEEP) for high grade cervical intra-epithelial neoplasia (CIN). Design: Compari son of the colposcopic and histological diagnosis in patients who rece ived LEEP treatment. Subjects: Subjects included 95 patients from May to October 1994. Setting: Department of Obstetrics and Gynaecology, th e Prince of Wales Hospital, the Chinese University of Hong Kong. Main outcome measures: Agreement between colposcopic and histological diagn osis and between histological diagnosis by biopsy and by LEEP. Sensiti vity and false positive rate of colposcopic diagnosis in different cla ssifications of high grade CIN lesions. Decision analysis on the cost of three proposed strategies based on the study results. Results: The colposcopic diagnosis was correct in 58% of cases with 31% overcall an d 11% undercall rates. The false positive rate of colposcopic examinat ion was 11.4% in the diagnosis of CIN III or more advanced lesions and 36.8% if CIN II lesions are also classified as high grade. Decision a nalysis showed a saving of: (i) US$53 000; or (ii) US$73 000 per annum if 'see and loop' was performed on all cases where colposcopic diagno sis is: (i) CIN III or more; or (ii) CIN II or more. If the cost of in appropriate surgery by LEEP is estimated to be more than US$550 per pe rson over-treated (i) becomes the preferred strategy. Conclusions: Sel ective 'see and loop' approach for high grade CIN III lesions suspecte d on colposcopy will not over-treat significantly but will reduce the number of colposcopy appointments, waiting list for colposcopy and sub sequent expenses. (C) 1997 Elsevier Science Ireland Ltd.