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F J Montz

Publications and source records attributed to F J Montz.

At least 37 records · Page 2Linked to original sources
PubMed2000

Large-scale serial analysis of gene expression reveals genes differentially expressed in ovarian cancer.

Difficulties in the detection, diagnosis, and treatment of ovarian cancer result in an overall low survival rate of women with this disease. A better understanding of the pathways involved in ovarian tumorigenesis will likely provide new targets for early and effective intervention. Here, we have used serial analysis of gene expression (SAGE) to generate global gene expression profiles from various ovarian cell lines and tissues, including primary cancers, ovarian surface epithelia cells, and cystadenoma cells. The profiles were used to compare overall patterns of gene expression and to identify differentially expressed genes. We have sequenced a total of 385,000 tags, yielding >56,000 genes expressed in 10 different libraries derived from ovarian tissues. In general, ovarian cancer cell lines showed relatively high levels of similarity to libraries from other cancer cell lines, regardless of the tissue of origin (ovarian or colon), indicating that these lines had lost many of their tissue-specific expression patterns. In contrast, immortalized ovarian surface epithelia and ovarian cystadenoma cells showed much higher similarity to primary ovarian carcinomas than to primary colon carcinomas. Primary tissue specimens therefore appeared to be a better model for gene expression analyses. Using the expression profiles described above and stringent selection criteria, we have identified a number of genes highly differentially expressed between nontransformed ovarian epithelia and ovarian carcinomas. Some of the genes identified are already known to be overexpressed in ovarian cancer, but several represent novel candidates. Many of the genes up-regulated in ovarian cancer represent surface or secreted proteins such as claudin-3 and -4, HE4, mucin-1, epithelial cellular adhesion molecule, and mesothelin. Interestingly, both apolipoprotein E (ApoE) and ApoJ, two proteins involved in lipid homeostasis, are among the genes highly up-regulated in ovarian cancer. Selected serial analysis of gene expression results were further validated through immunohistochemical analysis of ApoJ, claudin-3, claudin-4, and epithelial cellular adhesion molecule in archival material. These experiments provided additional evidence of the relevance of our findings in vivo. The publicly available expression data reported here should stimulate and aid further research in the field of ovarian cancer.

Cell Transformation, Neoplastic↗
PubMed2000

A model for predicting surgical outcome in patients with advanced ovarian carcinoma using computed tomography.

BACKGROUND: A reliable model for predicting the outcome of primary cytoreductive surgery may be a useful tool in the clinical management of patients with advanced epithelial ovarian carcinoma. METHODS: Forty-one women with a preoperative computed tomographic (CT) scan of the abdomen and pelvis and a histologic diagnosis of Stage III or IV epithelial ovarian carcinoma following primary surgery performed by one of nine gynecologic oncologists were identified from tumor registry databases. All CT scans were analyzed retrospectively using a panel of 25 radiographic features without knowledge of the operative findings. Patient demographics, surgical findings and outcome, Gynecologic Oncology Group performance status, and pre-operative serum CA125 values were collected from patient medical records. Residual disease measuring < or = 1 cm in maximal diameter was considered an optimal surgical result. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each radiographic feature and clinical characteristic. Based on statistical probability of each factor predicting cytoreductive outcome, 13 radiographic features, in addition to performance status, were selected for inclusion in the final model. Each parameter was assigned a numeric value based on the strength of statistical association, and a total Predictive Index score was tabulated for each patient. Receiver operating characteristic (ROC) curve analysis was used to assess the ability of the model to predict surgical outcome. Statistical significance was evaluated using the Fisher exact test. RESULTS: Twenty of 41 patients (48.8%) underwent optimal cytoreduction to </= 1 cm residual disease. CT features of peritoneal thickening, peritoneal implants (>/= 2 cm), bowel mesentery involvement (>/= 2 cm), suprarenal paraaortic lymph nodes (>/= 1 cm), omental extension (spleen, stomach, or lesser sac), and pelvic sidewall involvement and/or hydroureter were most strongly associated with surgical outcome. Using the Predictive Index scores, a receiver operating characteristic curve was generated with an area under the curve = 0. 969 +/- 0.023. In the final model, a Predictive Index score >/= 4 had the highest overall accuracy at 92.7% and identified patients undergoing suboptimal surgery with a sensitivity of 100% (21/21). The specificity, or ability to identify patients undergoing optimal surgery, was 85.0% (17/20). The PPV of a Predictive Index score >/= 4 was 87.5% (21/24), and the NPV was 100%. The ability of this model to correctly predict surgical outcome was statistically significant (P < 0.001). CONCLUSIONS: In this model, a Predictive Index score >/= 4 demonstrated high sensitivity, specificity, PPV, and NPV, and was highly accurate in identifying patients with advanced epithelial ovarian carcinoma unlikely to undergo optimal primary cytoreductive surgery. The Predictive Index model may have clinical utility in guiding the management of patients with ovarian carcinoma.

Adult↗
PubMed2000

Inability of preoperative computed tomography scans to accurately predict the extent of myometrial invasion and extracorporal spread in endometrial cancer.

OBJECTIVE: The purpose of this study was to assess the value of computed tomography (CT) scans in predicting preoperatively the depth of invasion and extrauterine spread in patients with endometrial cancer. METHODS: The records of 54 patients with endometrial cancer who underwent a preoperative CT scan and surgical treatment (36 of whom had complete surgical staging) were reviewed. Final pathological findings were compared with those of the CT scan. The ability of the CT scan to detect the depth of invasion of the tumor into the myometrium and extrauterine spread was assessed. RESULTS: The sensitivity of CT scans at predicting the depth of myometrial invasion (none, inner half, outer half) and cervical and parametrial spread was 10, 9, and 17%, respectively, and sensitivity in predicting any degree of myometrial invasion, lymph node metastasis, adnexal involvement, and the presence of malignant cells in peritoneal cytology was 61, 50, 60 and 57%, respectively. CONCLUSION: CT scan has limited usefulness in determining the depth of myometrial invasion or extent of tumor spread in patients with endometrial cancer. Its routine preoperative use is difficult to justify.

Aged↗
PubMed2000

Stage IVB endometrial carcinoma: the role of cytoreductive surgery and determinants of survival.

OBJECTIVE: The aim of this study was to evaluate the role of cytoreductive surgery and survival determinants in patients with Stage IVB endometrial carcinoma. METHODS: All patients with Stage IVB endometrial carcinoma diagnosed between 1/1/90 and 12/31/98 were identified from tumor registry databases. Individual patient data were collected retrospectively. Survival analyses and comparisons were performed using the Kaplan-Meier method and the log-rank test. The Cox proportional hazards model was used to identify independent variables associated with survival. RESULTS: Sixty-five patients underwent surgery as primary therapy for Stage IVB endometrial carcinoma (median survival 14.8 months). The median age of the population was 65 years (range 29-85 years); 89.2% of patients were postmenopausal, and 21.5% were nulliparous. The most common histologic subtypes were endometrioid (33.8%), serous (32.3%), and mixed (16.9%). Optimal cytoreductive surgery (residual tumor < or =1 cm in maximal diameter) was accomplished in 36 patients (55.4%), while 29 patients (44.6%) were left with >1 cm residual disease. The median survival rate of patients undergoing optimal surgery was 34.3 months, a statistically significant advantage compared to patients with >1 cm residual tumor (11.0 months, P = 0.0001). Among those with optimal surgery, patients with only microscopic residual disease survived significantly longer than patients with optimal but macroscopic residual tumor. Higher performance status, age < or = 58 years, and adjuvant chemotherapy followed by radiation therapy were also significantly associated with superior survival on univariate analysis. On multivariate analysis, residual disease (P = 0.0001), performance status (P = 0.043), and age (P = 0.023) were independent predictors of survival. CONCLUSIONS: The amount of residual disease after cytoreductive surgery, age, and performance status appear to be important determinants of survival in patients with Stage IVB endometrial carcinoma. Maximal cytoreduction should be the goal at the time of primary surgery for advanced disease. For selected patients, combined postoperative chemotherapy and radiation therapy may provide some therapeutic benefit.

Adult↗
PubMed2000

Retrograde seeding of malignant cells during hysteroscopy in presumed early endometrial cancer.

OBJECTIVE: The aim of this study was to determine the effect that preoperative hysteroscopy has on the frequency of positive cytology at the time of definitive surgical management in endometrial cancer. METHODS: Charts of 222 patients with endometrial cancer were reviewed. Patients were divided according to whether (n = 64) or not (n = 158) they had hysteroscopy with saline infusion. Each group was stratified into low or high risk for positive peritoneal cytology. Logistic regression analysis was used to compare the prevalence of positive peritoneal cytology with and without hysteroscopy, before and after the stratification, adjusting for the confounding risk factors. RESULTS: After adjusting for confounding variables there was a statistical difference in the frequency of positive peritoneal cytology in those who had hysteroscopy versus those who did not (odds ratio (OR) = 2.6, 95% confidence interval (CI) = 1.02-6.63, P = 0.05). Even after stratifying patients into a low-risk group (OR = 2.12, 95% CI = 0.13-35.9, P = 0.6) and a high-risk group (OR = 3.46, 95% CI = 1.3-9.12, P = 0.01) the difference in the high-risk group was statistically significant. CONCLUSION: Hysteroscopy seems to affect the prevalence of positive peritoneal cytology, especially in those patients with high-risk cell types. Its use in patients with suspicion of endometrial cancer should be reconsidered.

Aged↗
PubMed2000

Coexistent choriocarcinoma and malignant mixed mesodermal tumor of the uterus.

OBJECTIVE: The purpose of this article is to report a case of coexisting uterine choriocarcinoma and uterine malignant mixed mesodermal tumor (MMMT). The relevant literature is reviewed and possible pathogenesis discussed. METHODS: The clinical course and histopathology of the case were reviewed and a Medline literature search for other cases was performed. RESULTS: The patient's uterine tumor contained syncytiotrophoblastic and cytotrophoblastic cells that stained positively for the beta subunit of human chorionic gonadotrophin consistent with uterine choriocarcinoma. Pathology also revealed a second distinct neoplasm composed of adenocarcinoma admixed with sarcoma, compatible with a uterine MMMT. The patient experienced metastatic choriocarcinoma to her lungs, lymph nodes, and brain. She suffered a complicated clinical course and died 7 months after her initial diagnosis. The literature search revealed that various gynecologic and nongynecologic carcinomas with trophoblastic differentiation have been described, but an association with uterine MMMT has not been previously reported. CONCLUSIONS: Trophoblastic differentiation and choriocarcinoma associated with gynecologic and nongynecologic tumors is rare. We document the presence of uterine MMMT coexisting with uterine choriocarcinoma that followed an aggressive clinical course and review the possible pathogenesis of this lesion.

Adult↗
PubMed2000

Effects of human papillomavirus-associated cells on human immunodeficiency virus gene expression.

OBJECTIVE: To examine the effects of soluble factors secreted by human papillomavirus (HPV)-associated cells on human immunodeficiency virus (HIV) expression. METHODS: Supernatants collected from cultured cervical biopsies and cervical cancer cell lines, and HPV-immortalized and normal keratinocytes were tested for the ability to induce HIV p24 production in two cell lines that contained latent HIV (the U1 monocytic line and the ACH-2 T cell line). Levels of HIV p24 were measured by enzyme-linked immunosorbent assay (ELISA). Culture supernatants were also assayed for the inflammatory cytokines interleukin 6, tumor necrosis factor, and interleukin 1 beta by ELISA. RESULTS: Supernatants from all epithelial cells tested upregulated HIV p24 expression in the U1 line but not in the ACH-2 cells. Only differentiated normal keratinocytes induced p24 production by ACH-2 cells. Neutralization of the cytokines, particularly interleukin 6, partially reduced the level of HIV-inducing activity in the culture supernatants. Additionally, cervical biopsies from HIV-infected women cultured in vitro also were able to induce HIV in U1 cells but not ACH-2 cells. CONCLUSIONS: Our results suggest that HPV infection of the cervix might influence HIV pathogenesis by inducing the production of immune and inflammatory factors that enhance HIV expression.

Cervix Uteri↗
PubMed2000

Workup of the abnormal Pap test.

Cytologic evaluation of cells obtained from the cervix and vagina was first proposed by Papanicolaou and Traut in the 1940s as a method of detecting cervical cancer and its precursor lesions. Since that time, cervical cytology has proved to be the most efficacious and cost-effective method of cancer screening. By increasing detection of preinvasive and early invasive disease, use of Papanicolaou's (Pap) test has decreased both the incidence and mortality of cervical cancer in areas with well-established screening programs (1). The American Cancer Society has estimated that in the United States, cervical cancer will be diagnosed in 14,900 women and 4500 women will die as a result of this disease during the year 2000. More than 50 million Pap tests are performed annually in the United States, and about 5% of them will be abnormal (2). Consequently, it is incumbent on the practicing primary care physician to be familiar with the clinical significance and natural history of abnormal cervical cytologic diagnoses as well as the available treatment options. This discussion will delineate practical management protocols for the full range of cervical dysplasia commonly encountered in clinical practice.

Adult↗
PubMed2000

Prevalence of perioperative complications among women undergoing reconstructive pelvic surgery.

OBJECTIVE: The primary aim of this study was to report on the prevalence of perioperative complications associated with reconstructive pelvic surgery. A secondary aim was to identify risk factors predictive of perioperative complications in this population. STUDY DESIGN: A retrospective chart review was performed of 100 consecutive cases of reconstructive pelvic surgery. Statistical analysis included descriptive statistics and logistic regression. RESULTS: The prevalence of perioperative complications was 46%, including 13 intraoperative complications and 33 postoperative complications. The readmission rate for complications was 15%. The number of procedures per patient was an independent risk factor for intraoperative blood loss (P <.0038). Intraoperative estimated blood loss in turn was an independent risk factor for perioperative complications (P <.0001). CONCLUSIONS: Perioperative complications associated with reconstructive pelvic surgery were increased relative to those associated with general gynecologic surgery. The number of procedures per patient and associated blood loss appeared to contribute to the increase in perioperative complications.

Adolescent↗
PubMed2000

Management of stage I cervical cancer in pregnancy.

UNLABELLED: Although cervical carcinoma is the most common gynecologic malignancy associated with pregnancy, its occurrence is rare with an incidence of approximately 1 per 1,200 to 10,000 pregnancies. There are inadequate data addressing both the obstetric implications of the diagnostic evaluation and the impact of intervention on maternal and infant outcomes. Certain conclusions and recommendations, however, can be drawn from the available data. Diagnostic evaluation includes cytological screening, colposcopy and if necessary, biopsy, and selective conization. Staging of the pregnant patient is modified to minimize radiation exposure to the developing fetus. The treatment schema for patients with stage I cervical cancer in pregnancy varies with the stage of disease and gestational age at diagnosis. With close surveillance, deliberate delay of therapy to achieve fetal maturity is a reasonable option for patients with microinvasive and early stage IB cervical cancer. Tumor characteristics and maternal survival are not adversely affected by pregnancy. Conversely, cervical cancer does not seem adversely to affect pregnancy. However, timing and type of therapy may have a significant influence on the fate of the fetus. In counseling patients with cervical cancer during pregnancy, many factors must be considered, including the patient's desire for the pregnancy, stage of disease, and gestational age at diagnosis. Pregnant patients with stage I cervical cancer should be fully informed of all possible treatment options and consequences. The care of these patients should be closely coordinated by experts in perinatology and gynecologic oncology. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader will be able to describe the signs and symptoms of cervical cancer during pregnancy and the indications for conization during pregnancy, as well as being able to outline management strategies for the various stages of cervical cancer during pregnancy.

Adult↗
PubMed1999

A single-visit cervical carcinoma prevention program offered at an inner city church: A pilot project.

BACKGROUND: A single-visit cervical carcinoma prevention program was implemented, integrating screening, diagnosis, treatment, and health education in the familiar environment of the community church. METHODS: Nonpregnant women age 18 years or older, who had not received cervical carcinoma screening in the preceding year were eligible. Subjects provided information on personal demographics, health, and knowledge regarding cervical carcinoma prevention. Thereafter, cervical cytology was collected, processed, and interpreted on site. Participants attended small-group instruction on cervical carcinoma prevention. Screening results were given to each subject individually. Patients with abnormal cytology underwent immediate colposcopy with biopsies or loop electrosurgical excision procedure as indicated. Participant satisfaction and educational impact were evaluated. RESULTS: Ninety of the 98 participants reported that Spanish was their native language; 59 did not speak English. Fifty-four had had fewer than 6 years of education and 55 were unemployed. Seventy-eight did not have a regular physician or health insurance. Twenty-four either had never undergone cervical carcinoma screening or had let more than 5 years elapse since their previous examination. None of nine potential barriers assessed correlated with past compliance with cervical carcinoma screening. The mean time for processing and on-site interpretation of cervical cytology smears was 22.6 +/- 5.3 minutes. The median time patients spent in the program was 75 minutes. There was a significant improvement in the subjects' knowledge regarding cervical carcinoma prevention. All participants were highly satisfied. CONCLUSIONS: This parish-based, integrated, single-visit program for the prevention of cervical carcinoma was easily implemented and provided care to a substantial proportion of underserved patients.

Adult↗
PubMed1999

Survival impact of surgical cytoreduction in stage IV epithelial ovarian cancer.

OBJECTIVE: The aim of this study was to evaluate the influence of surgical cytoreduction on survival in patients with Stage IV epithelial ovarian cancer and to determine the survival impact of debulking extrahepatic disease in the subgroup of patients with liver metastasis. METHODS: Medical records were retrospectively reviewed for all women with International Federation of Gynecology and Obstetrics Stage IV ovarian cancer treated between 1/1/82 and 12/31/94. Clinical information abstracted included age at diagnosis, performance status, histologic subtype, tumor grade, Stage IV criteria, ascites volume, predominant peritoneal tumor pattern, surgical procedures performed, hepatic tumor residuum, extrahepatic tumor residuum, and postoperative complications. Optimal surgical status was defined as residual disease </=1 cm. Chemotherapy treatment and follow-up were recorded. Survival analysis and comparisons were performed using the Kaplan-Meier method and the log-rank test. The Cox proportional hazards regression model was used to identify independent variables associated with an improved survival rate. RESULTS: There were 84 women with Stage IV ovarian cancer and complete operative and postoperative information available. Median age at diagnosis was 61 years (range 26-85 years). Performance status was </=2 in 83% of patients (70/84). Papillary serous histology was found in 44/84 patients (52%) and 55 patients (65%) had grade 3 tumors. Thirty-seven of 84 patients (44%) had parenchymal liver metastasis and 32/84 (38%) had malignant pleural effusion. Overall median survival was 18.1 months and was highly correlated with performance status (P = 0.002), predominant peritoneal tumor pattern (P = 0.0002), and the number of chemotherapy regimens received (P = 0.0039). Primary surgical cytoreduction was attempted in all patients and 25/84 (30%) achieved optimal status. Median survival of optimally cytoreduced patients was 38.4 months, compared to 10.3 months for patients with suboptimal residual disease (P = 0.0004). In patients with liver metastasis, optimal extrahepatic cytoreduction was achieved in 46% (17/37). Six of 37 patients (16%) underwent optimal resection of both extrahepatic and hepatic disease and had a median survival of 50.1 months, compared to a median survival of 27.0 months for the 11 patients (30%) with optimal extrahepatic disease but suboptimal residual hepatic tumor. Twenty patients (54%) were left with both suboptimal residual extrahepatic and hepatic disease and had a median survival of 7.6 months (P = 0.0001). Optimal debulking surgery and performance status retained significance as independent predictors of survival on multivariate analysis. CONCLUSIONS: Optimal surgical debulking and performance status appear to be important determinants of survival in patients with Stage IV epithelial ovarian cancer. Even in patients with unresectable liver metastasis, optimal debulking of extrahepatic disease is associated with a significant survival advantage.

Adenocarcinoma↗
PubMed1999

Malignant struma ovarii: two case reports and a review of the literature.

Struma ovarii consists of thyroid tissue derived from germ cells in a mature teratoma. Malignant transformation is very rare, with clinically evident metastatic disease reported in approximately 20 cases. The rarity of this disease renders evaluation of treatment modalities difficult. There is evidence that these tumors behave like their thyroid counterparts, and cytoreductive surgery followed by ablation with radioactive iodine has been advocated. We report the diagnosis and treatment of 2 patients with metastatic malignant struma ovarii treated with a combination of surgery and radiation therapy.

Adult↗
PubMed1999

Ethnic differences in patterns of care of stage 1A(1) and stage 1A(2) cervical cancer: a SEER database study.

OBJECTIVE: The aim of this study was to evaluate patterns of care for women with Stage 1A(1) and 1A(2) cervical cancer utilizing the SEER database. METHODS: Review of SEER data from 11 registries from 1990 to 1995 was performed. Data from 2358 women were reviewed and stratified by substage, ethnicity, type of therapy, and age. RESULTS: Three remarkable differences among subgroups were identified. (1) Among women >/=35 years of age, whites were more likely to have Stage 1A(1) cancer than blacks or Hispanics; OR (95% CI) = 1.56 (1. 05, 2.31) and 1.41 (1.04, 1.91), respectively. (2) Patients >/=35 years of age were more likely to undergo hysterectomy than younger patients both for 1A(1) and 1A(2) stages; OR (95% CI) = 2.31 (1.68, 3.19) and 2.78 (2.21, 3.50), respectively, with Mantel-Haenszel test of independence chi(2) = 102.9943, P value < 0.001. (3) Black and Hispanic women >/=35 years of age with 1A(2) disease were less likely to have a hysterectomy than whites. Only 15% of Hispanic patients and 9% of blacks over the age of 35 and with Stage 1A(2) were treated via hysterectomy, compared to 76% of white women. Differences in hysterectomies for <35 years of age, 1A(1) patients approached but did not reach statistical significance: blacks 36% versus Hispanic/whites 59%, P value = 0.07. CONCLUSIONS: Older white women were more likely to have cervical carcinoma diagnosed at an earlier stage (1A(1)) than age-matched blacks or Hispanics. Older patients, across all ethnic groups analyzed, were also more likely to be treated for both Stage 1A(1) and 1A(2) disease via hysterectomy than younger patients. Ethnic differences in the management of women with Stage 1A(2) cervical cancer do exist: older minority women are less likely to have a hysterectomy and more likely to be treated via fertility-sparing, less definitive procedures than whites.

Adult↗
PubMed1999

Immunomodulation with interleukin-10 and interleukin-4 compared with ketorolac tromethamine for prevention of postoperative adhesions in a murine model.

OBJECTIVE: To assess the effects of two macrophage down-regulating cytokines (interleukin [IL]-10 and IL-4) and the nonsteroidal anti-inflammatory drug ketorolac tromethamine on postoperative adhesion formation. DESIGN: Randomized controlled trial. SETTING: Research center vivarium. ANIMAL(S): Six-week-old Swiss Webster mice. INTERVENTION(S): One hundred eighty animals were randomized to serve as nonsurgical controls or to undergo a standardized adhesion-inducing procedure. Subsequently, animals were randomized to nine different treatment groups to receive no injections, phosphate-buffered saline (PBS) only, IL-10, IL-4, ketorolac, IL-10 plus IL-4, IL-10 plus ketorolac, IL-4 plus ketorolac, or all three agents. MAIN OUTCOME MEASURE: Adhesion scores on postoperative day 10. RESULT(S): Postoperative adhesion scores were significantly reduced in all groups of animals treated with IL-10 or ketorolac. Animals treated with IL-4 showed a nonsignificant trend toward reduction of adhesions. There were significantly more animals with adhesion scores of < or = 3 in the IL-10 and ketorolac treatment groups than in the control groups receiving no treatment or PBS only. CONCLUSION(S): Although treatment with IL-10 and ketorolac did not completely prevent adhesion formation, treatment with these drugs did lead to a significant reduction in adhesion formation. Adhesions also tended to be thin and filmy rather than thick and vascular. Addition of IL-4 did not augment these effects.

Adjuvants, Immunologic↗
PubMed1999

See-and-treat in the management of high-grade squamous intraepithelial lesions of the cervix: a resource utilization analysis.

OBJECTIVE: To use activity-based costing techniques to compare see-and-treat with conventional evaluation and treatment of women presenting with a screening Papanicolaou smear demonstrating high-grade squamous intraepithelial lesion (SIL). METHODS: A total of 4000 theoretical patients were assumed to be evaluated and treated following one of four management algorithms: conventional algorithm I, with colposcopy and directed biopsies, followed by cryotherapy or cold-knife conization; conventional algorithm II, substituting the loop electrosurgical excision procedure for cold-knife conization; conventional algorithm III, substituting the loop electrosurgical excision procedure for cold-knife conization and cryotherapy; or see-and-treat algorithm IV, using the loop electrosurgical excision procedure. Costs associated with patient management in each algorithm were calculated including those for the procedure, patient time, physician time, and disposable expenses, as well as costs to manage complications, treatment failures, and follow-up for 1 year. RESULTS: Algorithm I was the most expensive, costing $899,405 for 1000 patients with high-grade SIL. Substituting the loop electrosurgical excision procedure for cold-knife conization (algorithm II) decreased the cost by 32%, whereas substituting it for cryotherapy also (algorithm III) reduced the cost by only 25%. The most cost-effective management was the see-and-treat single visit of algorithm IV. This strategy cost $531,281, offering a 41% cost reduction compared with algorithm I. CONCLUSION: A see-and-treat approach to the management of women with high-grade SIL, although incorporating more procedures, offers significant cost savings over conventional management algorithms.

Algorithms↗