A randomized trial of basing treatment on human papillomavirus and/or cytology results in low-grade cervical lesion triage

• OBJECTIVE: This study was undertaken to compare management algorithms that base treatment with loop electrosurgical excision procedure on human papillomavirus and/or repeat Papanicolaou test smear results. STUDY DESIGN: A randomized trial that referred 674 women with either atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesions cytology results, detected in organized screening to treatment either (1) if they were positive in a repeat Papanicolaou test smear and/or a human papillomavirus test or (2) if they were positive in the repeat Papanicolaou test smear test only. Women who tested positive were treated, regardless of colposcopic findings. RESULTS: There were 208 of 337 (62%) women who were treated in the human papillomavirus /Papanicolaou test smear group (187/337 because of HPV positivity) and 138 of 337 (41%) in the Papanicolaou test smear only group. Histopathologically diagnosed cervical intraepithelial neoplasia grade 2 or worse was found among 112 of 337 (33.2%) women in the human papillomavirus/Papanicolaou test smear group compared with 85 of 337 (25.2%) women in the Papanicolaou test smear only group (P < .05). Twenty-one women with cervical intraepithelial neoplasia 2+ had normal colposcopy. CONCLUSION: For adequate cervical intraepithelial neoplasia 2+ sensitivity, the decision to use loop electrosurgical excision procedure needs to be based on human papillomavirus testing results and should not exclude women with normal colposcopy.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Reproduktionsmedicin och gynekologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Obstetrics, Gynaecology and Reproductive Medicine (hsv//eng)

Nyckelord

Adult

Algorithms

Cervical Intraepithelial Neoplasia/pathology/*surgery/virology

Cervix Uteri/pathology/surgery/virology

Colposcopy

Electrosurgery/methods

Female

Humans

Middle Aged

Neoplasm Staging

Papillomaviridae/*isolation & purification

Treatment Outcome

Triage

Uterine Cervical Neoplasms/pathology/*surgery/virology

*Vaginal Smears

procedure

loop electrosurgical excision

colposcopy

intraepithelial neoplasia

atypical squamous cells of undetermined significance

cervical

randomized trial

atypical squamous cells of undetermined significance; cervical intraepithelial neoplasia; colposcopy; loop electrosurgical excision procedure; randomized trial

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)