การนำวิธีการ "ตรวจและตัด" มาใช้ในการดูแลรักษาสตรีที่มีผลการตรวจคัดกรองมะเร็งปากมดลูกผิดปกติที่มีความเสี่ยงสูงในโรงพยาบาลลำพูน

Chalita Kingnate

Authors

Chalita Kingnate Department of Obstetrics and Gynecology, Lamphun Hospital

Keywords:

High-grade cervical screening results, Cervical cancer, Colposcopy, Overtreatment, "See and Treat" approach

Abstract

Background: Implementing the "see and treat" approach to treat women with high-grade cervical screening results has advantages over the two-step conventional approach in terms of early detecting and treating high-grade cervical intraepithelial neoplasia (CIN) and occult invasive cervical cancer, reducing number of visits, shortening diagnosis to treatment time interval, reduction in patient anxiety and healthcare cost, with acceptable unnecessary or overtreatment rate and postoperative complications. Objective: To study the incidence of overtreatment rate, complications, waiting time, high-grade CIN, cervical cancer and identify clinical factors associated with overtreatment following application the "see and treat" approach in women with high-grade cervical screening results. Method: This retrospective cohort study was undertaken among women with high-grade cervical screening results who underwent a "see and treat" approach at Colposcopy Clinic, Lamphun Hospital from January 1st, 2020 to November 30th, 2024. Data was collected and analyzed using descriptive statistics, univariate and multivariate logistic regression. Result: 246 women were identified. The overtreatment rate in this study was 9.75%, and postoperative complications were bleeding (n = 4, 1.63%), infection (n = 14, 5.69%) and both (n = 1, 0.40%). The overall prevalence of high-grade CIN and cervical cancer was 90.25% (222/246). On univariate analysis, factors associated with overtreatment were age ≥50 years, menopause and atypical squamous cells cannot exclude HSIL (ASC-H) cervical cytology. On multivariate analysis, only ASC-H cervical cytology was significantly independent factor associated with overtreatment (adjOR 23.10, 95%CI: 5.11, 104.51, p-value <. 001). Conclusion: The "see and treat" approach can be used as alternative treatment option for women with high-grade cervical screening results to reduce the waiting time with an acceptable overtreatment rate and postoperative complications. ASC-H cytology should obtain a two-step conventional approach.

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