Treatment strategies in intermediate cervical neoplasia: Implications of radical surgery

Abstract

Abstract. Treatment strategies for cervical intraepithelial neoplase (CIN)2 lesions differ among gynaecologists. To evaluate the differences in management of treatment with subsequent implications, all surgical treatment strategies and follow-up methods were retrospectively analysed for patients with intermediate dysplasia of the cervix. This study aimed to evaluate expectant management strategies and the effect of biopsy prior to radical surgery in CIN2. Patients diagnosed with a CIN2 lesion at the Orbis Medical Center in The Netherlands between 2006 and 2007 were retrospectively analysed. The follow-up ended on 1st January 2009. All 141 patients with CIN2 lesions were included; 109 had no previous history of any CIN lesion. Of the 109 patients, 12% (n=13) underwent an immediate radical surgical excision of the transformation zone (LLETZ procedure) and 85% (n=93) underwent a local biopsy. After the lesion was biopsied, expectant management was selected for 59% of the patients. Subsequent smears were normal in 40% of the patients. Of the patients with abnormal smears in follow-up, the LLETZ procedure was performed in 86% of the patients (n=25). Of these cases, persistent disease was observed in 14% of the patients. After an immediate LLETZ procedure without prior biopsy, follow-up smears were abnormal in 31% of the patients. Persistent disease was significantly lower following radical excision of the lesion with a diagnostic biopsy versus without one (14 versus 31%). After expectant management, the rate of persistent disease was 53% (p<0.001). Overall, the rate of persistent disease was 7%. Due to the high rate of persistent disease and the lower rate of overtreatment, CIN2 lesions should be treated by the excisional procedure. To restrict persistent disease, a biopsy is recommended prior to the actual treatment, since a higher rate of abnormal smears was observed in the follow-up after immediate radical excisions in the first visit.

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

“…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).…”

“…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).…”

Prediction value with a novel and accurate tissue‐based human papillomavirus detection method in low‐grade squamous intraepithelial lesions

“… 31 Van Delft et al showed that among 109 CIN1 patients who underwent colposcopy, 47.71% were combined with CIN2 or worse. 32 In addition, Kinney et al and Barut et al reported that CIN3 is often missed or misdiagnosed as CIN1 or CIN2 using cytology and colposcopy in the initial screening procedure, because of low sensitivity and specificity, or sometimes due to poor technique, incorrect biopsy site, or the presence of multiple lesions with different grades of CIN. 33 , 34 Thus, for patients with the endpoint diagnosis of CIN1, how to avoid missing higher‐grade lesions while avoiding overtreatment has become a crucial challenge among gynecologists.…”

“…According to previous reports, in the cases diagnosed as CIN1 under colposcopy biopsy, the missed diagnosis rate of CIN2 and higher‐grade lesions is 19%–55% 31 . Van Delft et al showed that among 109 CIN1 patients who underwent colposcopy, 47.71% were combined with CIN2 or worse 32 . In addition, Kinney et al and Barut et al reported that CIN3 is often missed or misdiagnosed as CIN1 or CIN2 using cytology and colposcopy in the initial screening procedure, because of low sensitivity and specificity, or sometimes due to poor technique, incorrect biopsy site, or the presence of multiple lesions with different grades of CIN 33,34 .…”