Large Loop Diathermy of the Transformation Zone: Is 'See and Treat' An Acceptable Option for the Management of Women with Abnormal Cervical Smears?

Summary A total of J 39 women with dyskaryotic cervical smears, in whom the entire lesion could be visualised, were seen in the colposcopy clinic, and large loop diathermy of the transformation zone was performed, resulting in an over-treatment rate of 39 per cent. In 82 per cent of patients, a severely dyskaryotic referral smear resulted in a histologically proved lesion of CIN II or greater. Only 51 per cent of women referred with moderately dyskaryotic cervical smears had histologically proved CIN II or III. The results of further investigations, including repeat cervical smears, helped to improve the identification of high grade abnormalities in this second group, and would have reduced the over-treatment rate in this group. A 'see and treat' policy is an acceptable option for the management of women referred with severely dyskaryotic cervical smears, but if a woman is referred for colposcopy with a moderately dyskaryotic cervical smear, the policy of performing further investigations, including a repeat cervical smear, and a colposcopically directed punch biopsy before treatment, should be adhered to.