{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:57:43Z","timestamp":1785513463055,"version":"3.56.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      This study evaluated the overtreatment rate (defined as a histological finding of low-grade intraepithelial lesion or negative after cervical excisional procedures) associated with the \u2018see-and-treat\u2019 approach in patients undergoing cervical conization for citology-detected suspected high-grade cervical lesions. The \u2018see-and-treat\u2019 strategy consists of colposcopy and immediate excision without prior cervical biopsy when a high-grade lesion is suspected based on colposcopic impression. Secondary objectives were to compare this cohort with patients treated after histological confirmation of high-grade lesions and to identify clinical and epidemiological factors associated with increased overtreatment risk, to better select candidates for \u2018see-and-treat\u2019. We conducted a retrospective monocentric cohort study on women over 25 years of age with high-grade cytology who underwent an excisional procedure with or without a previous cervical biopsy. Overtreatment was defined as histopathology showing cervical intraepithelial neoplasia grade 1 or negative findings. Of the 892 patients included, 643 underwent the \u2018see-and-treat\u2019 approach. The overall overtreatment rate in this group was 13.5%, and 6% among women with both high-grade cytology and high-grade colposcopic impression (high-concordance subgroup). The factors most strongly associated with overtreatment were low-grade or negative colposcopic impression [odds ratio (OR): 7.36] and nonvisible squamocolumnar junction (OR: 3.57). Menopause (OR: 4.5,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001) and atypical squamous cells \u2013 cannot exclude HSIL cytology (OR: 2.97,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.0001) also increased the risk, whereas human papillomavirus 16\/18 positivity was associated with a lower risk (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.004). In the high-concordance subgroup, none of these factors showed significant correlation with overtreatment. The \u2018see-and-treat\u2019 approach appears particularly advantageous in cases with high-grade concordance, offering a low overtreatment rate and allowing the detection of 2.8% of invasive cancers that might have been missed by biopsy. Moreover, it significantly reduces the interval between colposcopy and treatment (29 vs. 68 days). These findings support the selective use of \u2018see-and-treat\u2019 in appropriately stratified patients.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/cej.0000000000001002","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T23:00:11Z","timestamp":1766617211000},"page":"465-472","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["The \u2018see-and-treat\u2019 approach in the treatment of preneoplastic cervical lesions"],"prefix":"10.1097","volume":"35","author":[{"given":"Ermelinda","family":"Monti","sequence":"first","affiliation":[{"name":"Gynecology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Monti","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Universit\u00e0 degli Studi di Milano"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Maria Michela","family":"Matozzo","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Salmaso","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Universit\u00e0 degli Studi di Milano"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Pasquali Coluzzi","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Universit\u00e0 degli Studi di Milano"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Di Loreto","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Libutti","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Boero","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Alberico","sequence":"additional","affiliation":[{"name":"Gynecology Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giussy","family":"Barbara","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences and Community Health, Universit\u00e0 degli Studi di Milano"},{"name":"Obstetric and Gynecological Emergency Unit and Service for Sexual and Domestic Violence, SVSeD, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"R2-20260731","first-page":"1723","article-title":"See and treat\u2019 approach is appropriate in women with high-grade lesions on either cervical cytology or colposcopy.","volume":"12","author":"Aue-Aungkul","year":"2011","journal-title":"Asian Pac J Cancer Prev"},{"key":"R3-20260731","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1111\/ajo.12450","article-title":"A retrospective observational study for the outcomes of women presenting to a colposcopy clinic with a high-grade Pap smear \u2013 implications for a \u2018see and treat\u2019 approach to management.","volume":"56","author":"Blain","year":"2016","journal-title":"Aust N Z J Obstet Gynaecol"},{"key":"R4-20260731","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1055\/s-0042-1744212","article-title":"When is there no benefit in performing a biopsy in the suspicion of intraepithelial lesions of the cervix?","volume":"44","author":"Bonow","year":"2022","journal-title":"Rev Bras Ginecol Obstet"},{"key":"R5-20260731","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1097\/AOG.0b013e318254f90c","article-title":"2011 Colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy.","volume":"120","author":"Bornstein","year":"2012","journal-title":"Obstet Gynecol"},{"key":"R6-20260731","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1097\/AOG.0b013e318293ab22","article-title":"Overtreatment in a see-and-treat approach to cervical intraepithelial lesions.","volume":"121","author":"Bosgraaf","year":"2013","journal-title":"Obstet Gynecol"},{"key":"R7-20260731","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S1470-2045(04)01712-7","article-title":"See-and-treat strategy for diagnosis and management of cervical squamous intraepithelial lesions.","volume":"6","author":"C\u00e1rdenas-Turanzas","year":"2005","journal-title":"Lancet Oncol"},{"key":"R8-20260731","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1097\/AOG.0b013e31818f5008","article-title":"Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2.","volume":"113","author":"Castle","year":"2009","journal-title":"Obstet Gynecol"},{"key":"R9-20260731","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/LGT.0000000000000455","article-title":"Factors related to overtreatment in the see-and-treat approach: a retrospective multicentric observational study.","volume":"23","author":"Ciavattini","year":"2019","journal-title":"J Low Genit Tract Dis"},{"key":"R10-20260731","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/1471-0528.13530","article-title":"Evidence supporting see-and-treat management of cervical intraepithelial neoplasia: a systematic review and meta-analysis.","volume":"123","author":"Ebisch","year":"2016","journal-title":"BJOG"},{"key":"R11-20260731","first-page":"372","article-title":"Three-step approach versus see-and-treat approach in patients with cytological abnormalities.","volume":"6","author":"Guducu","year":"2013","journal-title":"Int J Clin Exp Med"},{"key":"R12-20260731","first-page":"206","article-title":"How can the overtreatment rate of \u2018see and treat\u2019 approach be reduced in women with high-grade squamous intraepithelial lesion on cervical cytology?","volume":"8","author":"Kietpeerakool","year":"2007","journal-title":"Asian Pac J Cancer Prev"},{"key":"R13-20260731","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1159\/000365476","article-title":"The overtreatment risk of see-and-treat strategy in management of abnormal cervical cytology.","volume":"78","author":"Kim","year":"2014","journal-title":"Gynecol Obstet Invest"},{"key":"R14-20260731","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ygyno.2022.09.016","article-title":"Overtreatment rate after immediate local excision of suspected cervical intraepithelial neoplasia: a prospective cohort study.","volume":"167","author":"Kiviharju","year":"2022","journal-title":"Gynecol Oncol"},{"key":"R15-20260731","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1097\/LGT.0000000000000230","article-title":"See-and-treat loop electrosurgical excision procedure for high-grade cervical cytology: are we overtreating?","volume":"20","author":"Kuroki","year":"2016","journal-title":"J Low Genit Tract Dis"},{"key":"R16-20260731","doi-asserted-by":"crossref","first-page":"354.e1","DOI":"10.1016\/j.ajog.2019.10.004","article-title":"Clinical practice variation and overtreatment risk in women with abnormal cervical cytology in the Netherlands: two-step versus see-and-treat approach.","volume":"222","author":"Loopik","year":"2020","journal-title":"Am J Obstet Gynecol"},{"key":"R18-20260731","doi-asserted-by":"crossref","first-page":"e242309","DOI":"10.1001\/jamanetworkopen.2024.2309","article-title":"Preterm birth following active surveillance vs loop excision for cervical intraepithelial neoplasia grade 2.","volume":"7","author":"Lycke","year":"2024","journal-title":"JAMA Netw Open"},{"key":"R19-20260731","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1159\/000381842","article-title":"The Pap Test and Bethesda 2014. \u201cThe reports of my demise have been greatly exaggerated.\u201d (After a quotation from Mark Twain).","volume":"59","author":"Nayar","year":"2015","journal-title":"Acta Cytol"},{"key":"R20-20260731","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1158\/1055-9965.EPI-15-1044","article-title":"Overtreatment and cost-effectiveness of the see-and-treat strategy for managing cervical precancer.","volume":"25","author":"Nghiem","year":"2016","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"R21-20260731","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1097\/LGT.0000000000000525","article-title":"2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors.","volume":"24","author":"Perkins","year":"2020","journal-title":"J Low Genit Tract Dis"},{"key":"R23-20260731","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s12885-023-10648-1","article-title":"Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology.","volume":"23","author":"Qin","year":"2023","journal-title":"BMC Cancer"},{"key":"R24-20260731","first-page":"100205","article-title":"Overtreatment in the see-and-treat approach for high-grade squamous cervical cytology.","volume":"19","author":"Rongthongaram","year":"2023","journal-title":"Eur J Obstet Gynecol Reprod Biol X"},{"key":"R25-20260731","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.4103\/jcrt.JCRT_799_20","article-title":"Single step \u2018See and Treat\u2019 strategy might be replacing the \u2018conventional three step strategy\u2019 in management of preinvasive cervical lesions at tertiary center: a North Indian study.","volume":"18","author":"Sachan","year":"2022","journal-title":"J Cancer Res Ther"},{"key":"R28-20260731","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1097\/AOG.0000000000002812","article-title":"Risk of cervical intraepithelial neoplasia 2 or worse by cytology, human papillomavirus 16\/18, and colposcopy impression: a systematic review and meta-analysis.","volume":"132","author":"Silver","year":"2018","journal-title":"Obstet Gynecol"},{"key":"R29-20260731","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1097\/LGT.0000000000000229","article-title":"See-and-treat for high-grade cytology: do young women have different rates of high-grade histology?","volume":"20","author":"Smith","year":"2016","journal-title":"J Low Genit Tract Dis"},{"key":"R30-20260731","doi-asserted-by":"crossref","first-page":"k499","DOI":"10.1136\/bmj.k499","article-title":"Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis.","volume":"360","author":"Tainio","year":"2018","journal-title":"BMJ"},{"key":"R31-20260731","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1111\/1471-0528.13555","article-title":"See-and-treat: striking a balance between over- and under-treatment.","volume":"123","author":"Waxman","year":"2016","journal-title":"BJOG"}],"container-title":["European Journal of Cancer Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/CEJ.0000000000001002","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:02:45Z","timestamp":1785510165000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/CEJ.0000000000001002"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":26,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.1097\/cej.0000000000001002","relation":{},"ISSN":["0959-8278","1473-5709"],"issn-type":[{"value":"0959-8278","type":"print"},{"value":"1473-5709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]},"assertion":[{"value":"2025-08-05","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}