Are Women with Antecedent Low-Grade Cytology and &lt;CIN2 Findings in Colposcopy Being Overmanaged?

Page, Submission Cover; Bernard, Juliette; Mehros, Wala; Grégoire, Jean; Sebastianelli, Alexandra; Renaud, Marie-Claude; Douville, Pierre; Langlais, Eve‐Lyne; Plante, Marie

doi:10.1016/j.jogc.2022.06.012

Cited by 1 publication

(2 citation statements)

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“…Of these, 90 had low-grade changes on biopsy, 384 had a normal biopsy, and almost 3,700 did not have a biopsy. Among the total study population of 42,195 patients with <CIN2 diagnosed at colposcopy during the study period, participants referred for HG cytology represented 12.1% of this cohort but had a higher rate of subsequent CIN3+ and invasive cancer compared with those with low-grade referrals as previously reported 8 …”

Section: Resultsmentioning

confidence: 68%

“…7 In Ontario, it has previously been reported that the risk of subsequent CIN3+ in patients with low-grade cytology and <CIN2 colposcopy is sufficiently low to extend follow-up intervals to allow time for HPV infection to resolve and to provide sufficient colposcopy resources for patients who are truly at higher risk including those referred for primary HPV-positive or HG cytology. 8 However, longitudinal risk of CIN3+ for patients with HG cytology and <CIN2 colposcopy is less well reported.…”

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confidence: 99%

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Defining the Longitudinal Risk of CIN 3+ for <CIN 2 Colposcopy for Patients Referred With High-Grade Cytology

Piedimonte,

Tsang,

Jembere

et al. 2023

J Low Genit Tract Dis

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Objective To determine the baseline and cumulative risk of cervical intraepithelial neoplasia (CIN)3 and invasive cervical cancer in participants referred to colposcopy with high-grade cytology and <CIN2 histology, stratified by biopsy result. Methods The authors linked administrative databases including cytology, pathology, cancer registries, and physician billing history to identify participants referred to colposcopy between January 2012 and December 2013 with high-grade cytology (atypical squamous cells [ASC]-H, high-grade squamous intraepithelial lesion [HSIL], invasive squamous cell carcinoma, adenocarcinoma, atypical glandular cells [AGC], adenocarcinoma in situ) and had <CIN2 (with and without biopsy confirmation) at colposcopy. Three- and 5-year risks of CIN3 and invasive cervical cancer were generated using Kaplan-Meier survival analysis. Results Among 4,168 women referred to colposcopy for ASC-H, HSIL, squamous cell carcinoma, or adenocarcinoma, the 3- and 5-year CIN3 incidence rates were 17.7%/20.0% no biopsy, 13.0%/15.1% negative biopsy, and 18.9%/20.0% low-grade squamous intraepithelial lesion (LSIL) biopsies. The 3- and 5-year incidences of invasive cancer were: 1.25%/1.68% no biopsy, 0.78%/1.04% negative biopsy, and 0%/0% LSIL biopsy. When the initial cytology was AGC/adenocarcinoma in situ (n = 944), the 3- and 5-year rates of CIN3 were 7.42%/8.39% no biopsy, 7.41%/9.26% negative biopsy, and 7.69%/7.69% LSIL biopsy. The invasive cancer rates were 1.12%/1.54% no biopsy, 0.46%/0.46% negative biopsy, and 0.0%/0.0% LSIL biopsy. By screening cytology, participants referred for HSIL had the highest 3- and 5-year rates of CIN3 (18.9% and 21%) compared with AGC (7.22%/8.28%) and ASC-H (15.5%/18%). The 3- and 5-year invasive cancer rates were 1.38%/1.75% HSIL, 0.85%/1.17% AGC, and 0.91%/1.36% ASC-H. Conclusions In participants referred for high-grade cytology where colposcopy shows <CIN2, the subsequent risk of invasive cancer at 5 years is sufficiently elevated to warrant close surveillance in colposcopy.

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Section: Resultsmentioning

confidence: 68%

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confidence: 99%