Natural history of histologically moderate cervical dysplasia in adolescent and young women

Abstract

BackgroundAdolescent women are a special age group affected by human papilloma virus (HPV). Most guidelines recommend surgical treatment for high-grade cytological lesions. However, some reports have attempted to demonstrate that the immune system is fully capable of clearing the virus without using conization. Our aim in this study was to describe the outcome of women <25 years old with high-grade cytology pap smears and no histologically confirmed cervical intraepithelial neoplasm [CIN] III.MethodsThis prospective cohort study, carried out at the Department of Obstetrics and Gynecology, Hospital 12 de Octubre, included 29 women aged 25 years or younger with high-grade cytological lesions recruited in screening programs and were followed up at 15 months. This study describes the clinical course of the women, and we determined the percentage of cytological, histological, and microbiological lesions produced by HPV that were cleared without surgical treatment in these women during their follow-up.ResultsDuring follow-up, 63% of high-grade cytological lesions and all high-grade histological lesions were cleared. HPV was eliminated from 23% of patients with one HPV serotype and 27% with multiple HPV serotypes without any treatment.ConclusionThese results suggest that there is no need to use surgical treatment to clear high-grade cytological and cervical lesions in adolescent women, thus preventing damage to their reproductive future.

Is the colposcopic lesion size a predictor of high-grade lesions in young patients?

“…( 5 ) There is a low incidence of cancer among adolescents and young women is low, and there is evidence that screening is less efficient for detecting lesions. ( 3 , 6 , 7 ) Sasieni et al ( 8 ) showed that screening in women aged 20–24 years did not affect cervical cancer incidence until the age of 30 years. This finding supports the recommendation of observation over treatment for young women (aged 13–25) with grade 2 cervical intraepithelial neoplasia (CIN), as 68% of these cases resolve on their own within 3 years.…”