The Comparison Between the Treatment of 2-step Approach (See and treat regime) and 3-step Approach (Standard regime) Given to the Patients in Buriram Hospital Who had Cytologic Findings (Pap Smear) for High Grade Squamous Intraepithelial Lesion (HSIL)

Abstract

Objective: The aim of the study was to examine, diagnose and treat the patients who had high grade squamous intraepithelial lesion (HSIL) on pap smear with either 2-step approach, colposcope (see only),or 3-step approach, colposco pically directed biopsy (CDB) following LEEP and to compare the results of the two different treatments.
Method: Case Control Crosscetional study from January 2005 to June 2010, the data were collected from medical records of all 60 patients in Buriram Hospital who had HSIL on pap smear by retrospective review. The patients were divided into 2 groups ; group 1 (30 patients) were diagnosed and treated with 3-step approach, and group 2 (30 patients) with 2-step approach.
Results: Out of all 60 patients, it was found that in group 1(30 patients treated with 3-step approach) there were three patients with histologic findings following LEEP showing CIN 1 and two patients showing invasive squamous cell carcinoma (SCCA). เท group 2 (30 patients treaed with 2-step approach) three were four patients with histologic findings following LEEP showing CIN 1 and three patients showing invasive squamous cell carcinoma. The comparison between the two approaches, using statistic analysis (Fisher exact test), showed no statistically significant difference.
Summary: 2-step approach (See and treat), the examination, diagnosis and treatment with patients who had high grade squamous intraepithelial lesion on pap smear, was an alternative and appropriate procedure for the patients who had abnormal cytologic findings (HSIL) and showed no statistically significant difference when compared to 3-step approach. Therefore, it could help educe steps to visit the doctors and delay unnecessary treatment. Moreover, it did not need an expert colposcopist or a gynecologic oncologist who is rare in most provincial hospital, let alone, in district hospital.