Natural history of cervical intraepithelial neoplasia in pregnancy: postpartum histo-pathologic outcome and review of the literature

Abstract

BackgroundTo study the natural history of cervical intraepithelial neoplasia (CIN) during pregnancy and to compare the rates of persistence, progression and regression of CIN by colposcopically guided biopsy (CGB) during pregnancy with outcome in non-pregnant-women.MethodsA retrospective analysis of all pregnant women diagnosed with CIN at our outpatient clinic between 2005 and 2010 was performed. A CGB for histo-pathological analysis was obtained in all participants and observational management was performed. The histo-pathologic findings of initial and postpartum visits were collected. Rates of persistence, progression and regression of CIN were assessed. Results were compared to a matched control group of non-pregnant women where observational management was performed for at least three months. In addition a review of the literature and pooled analysis of published data was performed.ResultsA total of 51 pregnant women with CIN were included into analysis. CIN 1, 2, and 3 was diagnosed by CGB in 33.3, 13.7 and 52.9 % of all pregnant women, respectively. The postpartum histo-pathologic evaluation of the pregnant cohort revealed a significantly higher tendency to spontaneous regression (56.9 versus 31.4 %, p = 0.010) and a considerably, but not significantly higher complete remission rate (41.2 versus 27.5 %, p = 0.144) when compared to the non-pregnant cohort. In addition, we observed a significantly lower CIN persistence rate than in the non-pregnant cohort (39.2 versus 58.8 %, p = 0.048). The progression rate was notably low in the pregnant cohort (3.9 %) and no progression to invasive cancer was observed.ConclusionsCIN lesions show considerably high spontaneous regression rates postpartum. Once presence of invasive cancer is ruled out definitive treatment can be deferred to the postpartum period.

The prevalence and course of preinvasive cervical lesions during pregnancy in a Northern Nigerian Teaching Hospital

“…Some studies revealed pregnancy as having no effect on cervical neoplasia, whereas others have reported higher regression rates of cervical neoplasia in the postpartum period compared with spontaneous regression of neoplasia for nonpregnant women. [ 11 12 ] The hypothesis for the higher regression rate during pregnancy is that, in women with HPV infection, the typical hormonal pattern during pregnancy induces a viral activation that subsequently leads to increased spontaneous regression rates after delivery. [ 13 ] Some authors also believe that traumatic cervical desquamation and stimulation of local immune factors associated with vaginal delivery play an important role in spontaneous regression of cervical dysplasia in the postpartum period.…”

Disorders of the Cervix and Characteristics of Colposcopy in Pregnant Women

“…Современные данные о естественном течении интраэпителиальных неоплазий, подтвержденные гистологическим исследованием в послеродовом периоде (объединенный анализ 8 рандомизированных контролируемых исследований), свидетельствуют о том, что регресс, устойчивость и прогрессирование CIN наблюдается у 46,8%, 43,6% и 9,6% беременных женщин соответственно [14]. В обзоре уточняется, что некоторые авторы сообщают о показателях регресса от 37% до 74% после родов и о прогрессии лишь в 5,9% и 14,3% случаев в группах CIN I и CIN II соответственно [14].…”

“…В исследовании M. Mailath-Pokorny и соавт. частота прогрессирования CIN была низкой (3,9%), прогрессирование до инвазивного рака не наблюдалось [14]. Л.И.…”

Current management of gynecologic cancer in pregnancy

“…According to the literature, 0.4-10% of CIN II-III cases develop into invasive cancer ( 20 ). Conversely, 47-74% of cases regress ( 20 , 21 , 22 ). A conservative approach of pre-invasive lesions is necessary in order to avoid complications such as preterm labor.…”