Is the loop electrosurgical excision procedure necessary for minor cervical cytological abnormalities?

BACKGROUND To investigate the indications of loop electrosurgical excision procedure (LEEP) and its overtreatment rates for the see and treat and three step strategies in cases of atypical squamous cells of undetermined cytology (ASC-US) and low grade intraepithelial neoplasia (LGSIL) cytology. MATERIALS AND METHODS We retrospectively analyzed colposcopy directed biopsy (CDB) and LEEP results of 176 paients with ASC-US or LGSIL cytologies who underwent colposcopic examination. RESULTS Initial cytologies were ASCUS in 120 women and LGSIL in 56. According to the see and treat approach immediate LEEP was performed for38 women. Among the remaining 138 women, LEEP was performed for 32 whose CDB results revealed CIN2/3 lesions. In the see and treat group the recognition of CIN2/3 was found to be 39.4%. The overtreatment rate was 60% as compared to 25% in the three step group. In CDB group detection of CIN 2 or greater lesions increased with 3 or more biopsies. CONCLUSIONS In patients with ASC-US/LGSIL cytologies CDB should be performed before LEEP to prevent overtreatment, with attention to all suspected areas and more than 2 biopsies taken.