{"title":"在宫颈上皮内瘤变治疗中，“看即治疗”与“三步法”的过度治疗率、医疗费用和心理影响：一项系统回顾和荟萃分析","authors":"Shuwen Zhang, Jinhui Wang, Lan Zhu","doi":"10.1186/s12905-025-03718-y","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>The see-and-treat (S&T) approach is increasingly utilized for the treatment of cervical intraepithelial neoplasia (CIN). However, its recognition remains limited compared to the traditional three-step management. This study aims to systematically review and compare the outcomes of studies that directly assess the S&T and three-step approaches in CIN treatment.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in MEDLINE, EMBASE, and the Cochrane Library up to December 10, 2024. Eligible studies directly compared the overtreatment rate, medical costs, and psychological impact of the S&T and three-step approaches for abnormal cervical smears. The inclusion criteria for women undergoing S&T had to align with those for three-step management. Data on overtreatment risk, medical costs, and psychological effects were extracted and analyzed. Comparative results were presented using forest plots, stratified by different smear categories.</p><p><strong>Results: </strong>Twelve publications were included, comprising three randomized controlled trials (RCTs) and nine observational studies. Among women with ASC-H or HSIL, the overtreatment risk following S&T was comparable to that of the three-step approach (ASC-H, RR 1.40, 95% CI 0.75-2.60; HSIL, RR 0.93, 95% CI 0.71-1.23). However, in the LSIL/AS-CUS subgroup, the S&T approach was associated with a significantly higher overtreatment risk compared to the three-step method (RR 2.03, 95% CI 1.92-2.15). The S&T approach was associated with lower medical expenses for HSIL cases and a reduction in patients' negative emotional responses compared to the three-step procedure.</p><p><strong>Conclusions: </strong>The S&T approach may be a suitable alternative for women with HSIL/ASC-H smear results, considering its comparable overtreatment risk, potential cost savings, and psychological benefits. However, its use in LSIL/ASC-US cases should be carefully evaluated due to the increased risk of overtreatment.</p>","PeriodicalId":9204,"journal":{"name":"BMC Women's Health","volume":"25 1","pages":"179"},"PeriodicalIF":2.4000,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11998385/pdf/","citationCount":"0","resultStr":"{\"title\":\"The overtreatment rate, medical cost and psychological affection of see-and-treat versus three-step approaches in the treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis.\",\"authors\":\"Shuwen Zhang, Jinhui Wang, Lan Zhu\",\"doi\":\"10.1186/s12905-025-03718-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>The see-and-treat (S&T) approach is increasingly utilized for the treatment of cervical intraepithelial neoplasia (CIN). However, its recognition remains limited compared to the traditional three-step management. This study aims to systematically review and compare the outcomes of studies that directly assess the S&T and three-step approaches in CIN treatment.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in MEDLINE, EMBASE, and the Cochrane Library up to December 10, 2024. Eligible studies directly compared the overtreatment rate, medical costs, and psychological impact of the S&T and three-step approaches for abnormal cervical smears. The inclusion criteria for women undergoing S&T had to align with those for three-step management. Data on overtreatment risk, medical costs, and psychological effects were extracted and analyzed. Comparative results were presented using forest plots, stratified by different smear categories.</p><p><strong>Results: </strong>Twelve publications were included, comprising three randomized controlled trials (RCTs) and nine observational studies. Among women with ASC-H or HSIL, the overtreatment risk following S&T was comparable to that of the three-step approach (ASC-H, RR 1.40, 95% CI 0.75-2.60; HSIL, RR 0.93, 95% CI 0.71-1.23). However, in the LSIL/AS-CUS subgroup, the S&T approach was associated with a significantly higher overtreatment risk compared to the three-step method (RR 2.03, 95% CI 1.92-2.15). The S&T approach was associated with lower medical expenses for HSIL cases and a reduction in patients' negative emotional responses compared to the three-step procedure.</p><p><strong>Conclusions: </strong>The S&T approach may be a suitable alternative for women with HSIL/ASC-H smear results, considering its comparable overtreatment risk, potential cost savings, and psychological benefits. 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引用次数: 0
摘要
目的：观察治疗（S&T）方法越来越多地用于宫颈上皮内瘤变（CIN）的治疗。然而，与传统的三步管理相比，它的认知度仍然有限。本研究旨在系统回顾和比较直接评估科技和三步法治疗CIN的研究结果。方法：检索截至2024年12月10日的MEDLINE、EMBASE和Cochrane图书馆的文献。符合条件的研究直接比较了S&T和三步法对异常宫颈涂片的过度治疗率、医疗费用和心理影响。女性接受科学技术的标准必须与三步管理的标准保持一致。提取并分析了过度治疗风险、医疗费用和心理影响的数据。通过不同涂片类别分层的森林样地给出了比较结果。结果：纳入12篇出版物，包括3项随机对照试验（rct）和9项观察性研究。在患有ASC-H或HSIL的女性中，科技治疗后的过度治疗风险与三步法相当(ASC-H, RR 1.40, 95% CI 0.75-2.60；Hsil, rr 0.93, 95% ci 0.71-1.23)。然而，在LSIL/AS-CUS亚组中，与三步法相比，S&T方法的过度治疗风险显著更高（RR 2.03, 95% CI 1.92-2.15）。与三步手术相比，科技方法与HSIL病例的较低医疗费用和患者负面情绪反应的减少有关。结论：S&T方法可能是HSIL/ASC-H涂片结果女性的合适选择，考虑到其相当的过度治疗风险，潜在的成本节约和心理效益。然而，由于过度治疗的风险增加，应仔细评估其在LSIL/ASC-US病例中的使用。
The overtreatment rate, medical cost and psychological affection of see-and-treat versus three-step approaches in the treatment of cervical intraepithelial neoplasia: a systematic review and meta-analysis.
Objectives: The see-and-treat (S&T) approach is increasingly utilized for the treatment of cervical intraepithelial neoplasia (CIN). However, its recognition remains limited compared to the traditional three-step management. This study aims to systematically review and compare the outcomes of studies that directly assess the S&T and three-step approaches in CIN treatment.
Methods: A comprehensive literature search was conducted in MEDLINE, EMBASE, and the Cochrane Library up to December 10, 2024. Eligible studies directly compared the overtreatment rate, medical costs, and psychological impact of the S&T and three-step approaches for abnormal cervical smears. The inclusion criteria for women undergoing S&T had to align with those for three-step management. Data on overtreatment risk, medical costs, and psychological effects were extracted and analyzed. Comparative results were presented using forest plots, stratified by different smear categories.
Results: Twelve publications were included, comprising three randomized controlled trials (RCTs) and nine observational studies. Among women with ASC-H or HSIL, the overtreatment risk following S&T was comparable to that of the three-step approach (ASC-H, RR 1.40, 95% CI 0.75-2.60; HSIL, RR 0.93, 95% CI 0.71-1.23). However, in the LSIL/AS-CUS subgroup, the S&T approach was associated with a significantly higher overtreatment risk compared to the three-step method (RR 2.03, 95% CI 1.92-2.15). The S&T approach was associated with lower medical expenses for HSIL cases and a reduction in patients' negative emotional responses compared to the three-step procedure.
Conclusions: The S&T approach may be a suitable alternative for women with HSIL/ASC-H smear results, considering its comparable overtreatment risk, potential cost savings, and psychological benefits. However, its use in LSIL/ASC-US cases should be carefully evaluated due to the increased risk of overtreatment.
期刊介绍：
BMC Women''s Health is an open access, peer-reviewed journal that considers articles on all aspects of the health and wellbeing of adolescent girls and women, with a particular focus on the physical, mental, and emotional health of women in developed and developing nations. The journal welcomes submissions on women''s public health issues, health behaviours, breast cancer, gynecological diseases, mental health and health promotion.
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