Outcomes After Management of Young Women With Cervical Intraepithelial Neoplasia 2 With a 6-Month Observation Protocol

Bleecker, Elizabeth; Koehler, Elizabeth; Smith, Jennifer; Budwit, Debra; Rahangdale, Lisa

doi:10.1097/lgt.0b013e3182901ef3

Cited by 9 publications

(14 citation statements)

References 11 publications

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“…To our knowledge, this is the first study to compare regression rates between women with CIN2 versus CIN3 managed conservatively, and it is one of the largest cohorts published regarding outcomes of conservative management of CIN2 in young women. Importantly, in terms of the primary outcome, it confirms previously published high regression rates in this age group for those with CIN2 7 , 8 , 10 , 11 , 15 , 16 with a median time to regression of 10.8 months. In addition, we have documented a regression rate of 21.6% for women with CIN3, median not reached.…”

Section: Discussionsupporting

confidence: 86%

“… 1 Reasons for this include low incidence of cervical cancer, 1 – 5 high rate of false-positive screening tests, 6 and spontaneous resolution of precancerous lesions. 7 – 16 An increasing number of studies have demonstrated a high rate of regression of high grade squamous intraepithelial lesion (HSIL) (52.4%–71.1%) 7 , 8 , 10 , 11 , 13 – 16 in women younger than 25 years, suggesting that treatment is often unnecessary. One UK study estimated that at most, 1.5% of young women treated for HSIL would have developed cancer by the age of 25 years, if left untreated, whereas more than half of them would have regressed by the age of 25 years.…”

mentioning

confidence: 99%

“…This guideline was more conservative than those suggested in 2012 by the American Society of Colposcopy and Cervical Pathology 23 and the Society of Obstetricians and Gynaecologists of Canada, 24 which recommended treatment of CIN3 while allowing conservative management of CIN2, and CIN2,3. 11 , 24 Although several studies have reported clinical outcomes or protocols of conservative management in young women with CIN2 and CIN2/3, 7 , 8 , 10 , 11 , 15 , 16 , 25 there are no published studies examining outcomes in young women with CIN3 (versus CIN2,3) managed conservatively.…”

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confidence: 99%

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Outcomes of Conservative Management of High Grade Squamous Intraepithelial Lesions in Young Women

Lee

Finlayson

Gukova

et al. 2018

J Low Genit Tract Dis

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ObjectiveThe aim of the study was to determine regression rates of cervical intraepithelial neoplasia (CIN) 2 and 3 in women younger than 24 years, followed conservatively for up to 24 months.Materials and MethodsThis is a retrospective chart review of colposcopy patients in clinic database based on the following: (1) younger than 24 years at first visit; (2) first visit January 1, 2010, to May 31, 2013, and at least 1 follow-up visit after diagnosis; (3) histologic diagnosis of CIN2+; and (4) optimal conservative management (observation for up to 24 months or to 24 years, whichever occurred first). Patient information and clinical/pathologic data were extracted from charts to examine patient characteristics and treatment outcomes, CIN2+ regression rates, median times to regression for CIN2 versus CIN3 (Kaplan-Meier survival analysis), and predictors of regression (multivariate logistic regression analysis).ResultsA total of 154 women met criteria. The most severe histological diagnoses were CIN2 in 99 (64.3%), CIN3 in 51 (33.1%), and adenocarcinoma in situ in 4 (2.6%). Adenocarcinoma in situ was immediately treated. In follow-up, CIN2 regressed to CIN1 or negative in 74 women (74.7%)-median time to regression, 10.8 months. Cervical intraepithelial neoplasia 3 regressed in 11 women (21.6%)-median time to regression not reached (last follow-up censored at 52.7 months). Cervical intraepithelial neoplasia 2 on biopsy, low grade referral Pap, and younger age predicted regression. Overall, 49 women (31.8%) were treated.ConclusionsConservative management should continue to be recommended to young women with CIN2. Rigorous retention mechanisms are required to ensure that these women return for follow-up.

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Section: Discussionsupporting

confidence: 86%

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confidence: 99%

mentioning

confidence: 99%

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Outcomes of Conservative Management of High Grade Squamous Intraepithelial Lesions in Young Women

Lee

Finlayson

Gukova

et al. 2018

J Low Genit Tract Dis

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“…We identified 250 potentially eligible studies; 43 publications met the inclusion criteria (fig 1),6222324252627282930313233343536373839404142434445464748495051525354555657585960616263 but seven were duplicate reports of the same data 27283140505254. Of the 36 eligible studies (total of 3160 women), seven (19%) were randomised trials with suitable data in the non-experimental arm,22253339455762 16 (44%) were prospective cohort studies,6263032343536373841435155566063 and 13 (36%) were retrospective cohort studies23242942444647484953585961 (see supplementary table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 36 eligible studies (total of 3160 women), seven (19%) were randomised trials with suitable data in the non-experimental arm,22253339455762 16 (44%) were prospective cohort studies,6263032343536373841435155566063 and 13 (36%) were retrospective cohort studies23242942444647484953585961 (see supplementary table 2). The median follow-up was 16 months (range 3-72, interquartile range 7.6-27.4 months).…”

Section: Resultsmentioning

confidence: 99%

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Tainio

Athanasiou

Tikkinen

et al. 2018

BMJ

253

242

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ObjectiveTo estimate the regression, persistence, and progression of untreated cervical intraepithelial neoplasia grade 2 (CIN2) lesions managed conservatively as well as compliance with follow-up protocols.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1 January 1973 to 20 August 2016.Eligibility criteriaStudies reporting on outcomes of histologically confirmed CIN2 in non-pregnant women, managed conservatively for three or more months.Data synthesisTwo reviewers extracted data and assessed risk of bias. Random effects model was used to calculate pooled proportions for each outcome, and heterogeneity was assessed using I2 statistics.Main outcome measuresRates of regression, persistence, or progression of CIN2 and default rates at different follow-up time points (3, 6, 12, 24, 36, and 60 months).Results36 studies that included 3160 women were identified (seven randomised trials, 16 prospective cohorts, and 13 retrospective cohorts; 50% of the studies were at low risk of bias). At 24 months, the pooled rates were 50% (11 studies, 819/1470 women, 95% confidence interval 43% to 57%; I2=77%) for regression, 32% (eight studies, 334/1257 women, 23% to 42%; I2=82%) for persistence, and 18% (nine studies, 282/1445 women, 11% to 27%; I2=90%) for progression. In a subgroup analysis including 1069 women aged less than 30 years, the rates were 60% (four studies, 638/1069 women, 57% to 63%; I2=0%), 23% (two studies, 226/938 women, 20% to 26%; I2=97%), and 11% (three studies, 163/1033 women, 5% to 19%; I2=67%), respectively. The rate of non-compliance (at six to 24 months of follow-up) in prospective studies was around 10%.ConclusionsMost CIN2 lesions, particularly in young women (<30 years), regress spontaneously. Active surveillance, rather than immediate intervention, is therefore justified, especially among young women who are likely to adhere to monitoring.Systematic review registrationPROSPERO 2014: CRD42014014406.

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Non-steroidal anti-inflammatory agents to induce regression and prevent the progression of cervical intraepithelial neoplasia

Grabosch

Shariff

Wulff

et al. 2014

Cochrane Database of Systematic Reviews

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Outcomes After Management of Young Women With Cervical Intraepithelial Neoplasia 2 With a 6-Month Observation Protocol

Cited by 9 publications

References 11 publications

Outcomes of Conservative Management of High Grade Squamous Intraepithelial Lesions in Young Women

Outcomes of Conservative Management of High Grade Squamous Intraepithelial Lesions in Young Women

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Non-steroidal anti-inflammatory agents to induce regression and prevent the progression of cervical intraepithelial neoplasia

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