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T he optimal management of women with cervical intraepithelial neoplasia grade 1 (CIN1) diagnosed by colposcopically directed cervical biopsy is not clear. A 1997 survey of Ontario gynecologists confirmed this uncertainty, revealing that 46% of responding physicians immediately would treat the cervix of women with biopsy-proven CIN1 and that 42% would follow such women colposcopically and would treat only if the disease persisted or progressed (Dr. R. Osborne, personal communication).Physicians advocate immediate treatment of CIN1 for two reasons: to prevent persistent or progressive disease [1,2] and to minimize sexual transmission of the virus associated with CIN1 [3]. Only one study in the literature, a case series, describes the long-term results of women treated immediately for biopsy-proven CIN1 [2].We undertook a retrospective cohort study to determine the rates of CIN2, CIN3, and cancer in women who presented with biopsy-proven CIN1 and received Abstract Objective. Our goal was to evaluate, using a retrospective cohort study design, the management and outcome of 403 women with a colposcopic biopsy of cervical intraepithelial neoplasia grade 1 (CIN1).Methods. Patients were identified from a database of 3,782 new colposcopy patients from 1990 to 1996. CIN1 on initial biopsy was identified in 505 women, and inclusion criteria were met by 403. Management and follow-up information was retrieved from the colposcopy record and computerized pathology information system.Results. Management consisted of immediate treatment for 112 women (cone biopsy, 4; cryotherapy, 26; laser ablation, 79; loop electrosurgical excision, 3) and follow-up for 291 women (colposcopy follow-up, 192; cytology follow-up by family doctor, 99). In patients with a CIN1 biopsy and an index Papanicolaou smear no more serious than atypia, 78% had follow-up only. If the index cytology showed CIN1, 51% had immediate treatment.Conclusion. Conservative management of patients with biopsy-proven CIN1 appears to be appropriate, as 64.6% of pa-tients with follow-up reverted to benign cytology. However, compliance with follow-up must be ensured, as the failure rate of immediate treatment is not insignificant at 21%.

2022-RA-460-ESGO Figure 1 Conclusion These results establish a link between EMPs and the acquisition of endometrial cancer driver mutations. Based on these findings, we propose a model where the association between EMPs and endometrial cancer is explained by the age-related accumulation of endometrial cancer drivers in a protected environment that-unlike normal endometrium-is not subject to cyclical shedding. Our results also provide further justification for hysteroscopic removal of endometrial polyps, when clinically feasible.

73 Background: Robust quality assurance (QA) programs incorporating both technical and interpretive aspects of QA are integral to accurate pathology diagnosis and quality of care a cancer patient receives. Programs and governance addressing technical pathology quality have been well developed in Canada and internationally. The extent of interpretive pathology QA implementation across Canada remains unknown. The objective of this study was to document the current landscape for pathology QA in Canada. Methods: An environmental scan was conducted to determine the types and extent of current large institution and provincial-level pathology QA programs in place across Canada. An electronic survey was administered to key stakeholders and senior decision makers in cancer pathology. Targeted interviews were conducted with pathology leaders in each province to verify survey results, deliberate and resolve ambiguous responses. Results were presented to all survey respondents as a feedback mechanism. Results: 9/10 provinces currently have a professional group representing pathologists. 10/10 provinces currently have a technical QA program. Of these, 2/10 provinces are governed through Accreditation Canada, 3/10 provinces are governed through the Ontario Laboratory Accreditation Program and the remaining 5/10 provinces are governed by separate provincially-led programs. For interpretive pathology QA, 2/10 provinces have a coordinated provincial interpretive QA program, 5/10 provinces do not have provincial coordination, and have plans to implement one, and 3/10 provinces do not have a provincially coordinated interpretive QA program in place, nor are they planning to develop one. Conclusions: This is the first study to document the provincial landscape for pathology QA in Canada. Large pan-Canadian variations remain for level of integration and future plans to develop and integrate interpretive pathology QA programs within provinces. Next steps should include the development of a pan-Canadian recommendations framework for interpretive pathology QA to help guide senior decision-makers in implementing such quality programs provincially.