1. An Audit of Colposcopy Practice on Mild Dyskaryosis or Borderline Changes on Cervical Smear and the Effectiveness of
“See & Treat” vs. Biopsy and Recall (TOMBOLA Group Protocol) in a DGH Setting
Dr M A Shiraz; Ms Tracey Speed; Mr Khalil Razvi
Southend University Hospital
P048
Introduction
Results
Current gynaecological practice for cervical smears with borderline change/ mild dyskaryosis is “See and Treat” at Colposcopy1. The TOMBOLA trial2 demonstrated that this policy was of no advantage compared to a policy of biopsy and recall. This means that a significant proportion of our patients are being over treated, leading to patient morbidity by way of pain and bleeding3. Given these implications we set about validating the TOMBOLA group findings on our own colposcopy population. Thus, here we present our results based on two years (2011/2012) of data.
Methods
Our colposcopy service maintains a database of all our colposcopy patients including their original cervical smear result together with the colposcopy findings (± treatment) and further follow up as per our local protocols. Using this database we identified all patients that had initial smear results of Borderline Change vs. Mild Dyskaryosis for the years 2011 & We then analysed what proportion of these patients subsequently underwent See & Treat vs. Biopsy & Recall. We further looked at what the final histology of each case was and analysed the proportion of patients that had high risk features i.e. CIN II/ III.
Fig 2. Of the 459 Mild Dyskaryosis 415 patients had Biopsy & Recall. Of these only 31% had high risk histology
Fig 3. Of the 635 Borderline Change patients 550 patients had Biopsy & Recall, of these only 28% had high risk histology
Fig 1. Profile of Patients
Conclusions
Given the above results we support the TOMBOLA group findings of promoting Biopsy & Recall over the current policy of See & Treat. We feel that this is appropriate given the high yield of less aggressive cases that we see at Colposcopy.
References
1) Cárdenas-Turanzas, Marylou, et al. The lancet oncology 6.1 (2005):
2) TOMBOLA group BMJ: British Medical Journal 339 (2009)
3) TOMBOLA, The. "After‐effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial." BJOG: An International Journal of Obstetrics & Gynaecology (2009):