The ‘see-and-treat’ approach in the treatment of preneoplastic cervical lesions

This study evaluated the overtreatment rate (defined as a histological finding of low-grade intraepithelial lesion or negative after cervical excisional procedures) associated with the 'see-and-treat' approach in patients undergoing cervical conization for citology-detected suspected high-grade cervical lesions. The 'see-and-treat' strategy consists of colposcopy and immediate excision without prior cervical biopsy when a high-grade lesion is suspected based on colposcopic impression. Secondary objectives were to compare this cohort with patients treated after histological confirmation of high-grade lesions and to identify clinical and epidemiological factors associated with increased overtreatment risk, to better select candidates for 'see-and-treat'. We conducted a retrospective monocentric cohort study on women over 25 years of age with high-grade cytology who underwent an excisional procedure with or without a previous cervical biopsy. Overtreatment was defined as histopathology showing cervical intraepithelial neoplasia grade 1 or negative findings. Of the 892 patients included, 643 underwent the 'see-and-treat' approach. The overall overtreatment rate in this group was 13.5%, and 6% among women with both high-grade cytology and high-grade colposcopic impression (high-concordance subgroup). The factors most strongly associated with overtreatment were low-grade or negative colposcopic impression [odds ratio (OR): 7.36] and nonvisible squamocolumnar junction (OR: 3.57). Menopause (OR: 4.5, P < 0.0001) and atypical squamous cells - cannot exclude HSIL cytology (OR: 2.97, P < 0.0001) also increased the risk, whereas human papillomavirus 16/18 positivity was associated with a lower risk (P = 0.004). In the high-concordance subgroup, none of these factors showed significant correlation with overtreatment. The 'see-and-treat' approach appears particularly advantageous in cases with high-grade concordance, offering a low overtreatment rate and allowing the detection of 2.8% of invasive cancers that might have been missed by biopsy. Moreover, it significantly reduces the interval between colposcopy and treatment (29 vs. 68 days). These findings support the selective use of 'see-and-treat' in appropriately stratified patients.