Another potential use of the LEEP procedure is diagnosing and treating some patients in a single visit. The so-called "see and treat method" offers advantages and disadvantages over the currently recommended method of standard therapeutic LEEP after directed colposcopic biopsy.34 It has been proposed for patients with evidence of high grade dysplasia (not LGSIL or HPV lesions) on Pap smear cytology with visible lesions and an adequate colposcopic exam. It should not be used when colposcopic findings are equivocal or suggestive of invasive cancer.
A potential advantage of LEEP is that diagnosis and therapy can be done in one clinic visit with one pelvic exam. It may also provide better tissue samples than punch biopsies, leading to better histological diagnosis. Patient discomfort and loss of follow-up before treatment, with its concomitant risk of cancer, also may be decreased. In addition, patient's anxiety while awaiting pathology results and anticipating treatment may be lessened or eliminated.
The major concern with this approach is that the procedure may be performed
on patients who do not need it (Table 6). Approximately 5 to 47 percent
of patients could be treated unnecessarily (including HPV lesions without
a SIL). 31, 32, 34, 44, 45 The histology fees tend to be higher with this
method, and a patient with HPV effect, LGSIL, or normal tissue will pay
significantly more and be exposed to unnecessary risk. The study by Roland,
et al., demonstrated that traditional colposcopy followed by treatment
was more cost-effective than "see and treat" LEEP. 45 The morbidity and
mortality from the possibility of missing invasive disease must be weighed
against the potential cost and morbidity of the procedure.
Table 6. "See and Treat" LEEP effects from the English language literature.
Ref. # in Over- Under- Pap Smear Follow-up Study tx tx* Normalization Time -------------------------------------------------- 6 1000 - 5.3% 95.9% 4 months 31 236 14% 1.7 % 91.3% 4-6 months 32 185 32.5% 0.5% 93.3% 6 months 33 424 - - 81% 4.7 years 34 1000 4.7% 0.5% 96.7% 8 months 44 114 14% 0.9% - none 45 46.7 46.7% - - none* Incomplete excision or presence of cancer.
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