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Colposcopy Cost Effective for Cervical Lesions

Colposcopy Cost Effective for Cervical Lesions

SAN FRANCISCO--For physicians who treat cervical lesions, abandonment
of traditional colposcopy for one-step loop excision procedures
could lead to excessive treatment and excessive expense, Philip
Roland, MD, said at the Society of Gynecologic Oncologists meeting.

Published reports have suggested that immediate LLETZ (large loop
excision of the transformation zone) may be performed at the initial
patient visit, providing diagnosis and treatment in a single procedure,
said Dr. Roland, a GYN Oncology Fellow at the University of Alabama
at Birmingham.

Proponents of immediate LLETZ see it as an effective way to save
time and money by eliminating the expertise needed for colposcopy,
he said.

However, a decision analysis study by Dr. Roland and his colleagues
at Birmingham showed that colposcopy followed by observation of
mild dysplasia and treatment of moderate to severe dysplasia was
the most cost effective of four possible management scenarios
and offered the least opportunity for overtreatment of lesions.

The results did indicate that a subset of patients with high-grade
squamous intraepithelial lesion (SIL)/severe dysplasia may be
better candidates for immediate LLETZ, he said.

The researchers constructed clinical algorithms for four different
philosophies for the management of a patient with an abnormal
Pap smear, and used decision analysis methodology to evaluate
the expense of each algorithm and the potential for excessive
treatment. The algorithms were as follows:

  1. Colposcopy with treatment of all biopsy-proven dysplasia
    (cryotherapy of mild dysplasia and LLETZ of moderate to severe
    dysplasia).
  2. Colposcopy with observation of biopsy-proven mild dysplasia
    (a spontaneous regression rate of 50% at 1 year was assumed) and
    treatment of moderate dysplasia (cryotherapy) and severe dysplasia
    (LLETZ).
  3. Colposcopy of Bethesda System low-grade SIL and immediate
    LLETZ of high-grade SIL.
  4. Immediate LLETZ of all high-grade SIL and low-grade SIL Pap
    smears.

These algorithms were theoretically applied to 614 dysplasia patients
at the Birmingham colposcopy clinic, based on referral Pap smear
results: 47% had smears showing low-grade SIL; 52% showed high-grade
SIL.

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