The Natural History of Cervical Intraepithelial Neoplasia Grades 1, 2, and 3: A Systematic Review and Meta-analysis.

IF 2.4 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Journal of Lower Genital Tract Disease Pub Date : 2021-07-01 DOI:10.1097/LGT.0000000000000604

Diede L Loopik, Heidi A Bentley, Maria N Eijgenraam, Joanna IntHout, Ruud L M Bekkers, James R Bentley

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引用次数: 28

Abstract

Objective: The aim of the study was to obtain an updated overview of regression, persistence, and progression rates of conservatively managed cervical intraepithelial neoplasia grade 1 (CIN 1)/CIN 2/CIN 3.

Methods: Data sources were MEDLINE, Embase, and Cochrane (January 1, 1973-April 14, 2020). Two reviewers extracted data and assessed risk of bias. To estimate outcome rates, we pooled proportions of the individual study results using random-effects meta-analysis, resulting in point estimates and corresponding 95% CIs. Heterogeneity was quantified by the I2 and τ2 measures.

Results: Eighty-nine studies were included, 63 studies on CIN 1 (n = 6,080-8,767), 42 on CIN 2 (n = 2,909-3,830), and 7 on CIN 3 (n = 245-351). The overall regression, persistence, and progression to CIN 2 or worse and CIN 3 or worse rates for women with conservatively managed CIN 1 were 60% (95% CI = 55-65, I2 = 92%), 25% (95% CI = 20-30, I2 = 94%), 11% (95% CI = 8-13, I2 = 89%), and 2% (95% CI = 1-3, I2 = 82%), respectively. The overall regression, persistence, and progression rates for CIN 2 were 55% (95% CI = 50-60, I2 = 85%), 23% (95% CI = 19-28, I2 = 83%), and 19% (95% CI = 15-23, I2 = 88%), respectively. Finally, for CIN 3, these were 28% (95% CI = 17-41, I2 = 68%), 67% (95% CI = 36-91, I2 = 84%), and 2% (95% CI = 0-25, I2 = 95%), respectively. Cervical intraepithelial neoplasia grade 2 regression was significantly higher in women 30 years or younger and high-risk human papillomavirus-negative women (66%, 95% CI = 62-70, I2 = 76%; 94%, 95% CI = 84-99, I2 = 60%). Only 2/7,180 (0.03%) and 10/3,037 (0.3%) of the CIN 1 and CIN 2 cases progressed to cervical cancer.

Conclusions: Most CIN 1/CIN 2 will regress spontaneously in less than 24 months, with the highest rates in high-risk human papillomavirus-negative and young women, whereas progression to cancer is less than 0.5%. Conservative management should be considered, especially in fertile women and with expected high compliance. Given the heterogeneity in regression rates of high-grade histology, this should be classified as CIN 2 or CIN 3 to guide management.

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宫颈上皮内瘤变1级、2级和3级的自然史:系统回顾和荟萃分析

目的:该研究的目的是获得保守治疗宫颈上皮内瘤变1级(CIN 1)/CIN 2/CIN 3的消退、持续和进展率的最新概况。方法:数据来源为MEDLINE、Embase和Cochrane(1973年1月1日- 2020年4月14日)。两名审稿人提取数据并评估偏倚风险。为了估计转归率，我们使用随机效应荟萃分析汇总了各个研究结果的比例，得出了点估计和相应的95% ci。异质性通过I2和τ2测量来量化。结果:纳入89项研究，其中CIN 1研究63项(n = 6080 - 8767)， CIN 2研究42项(n = 2909 - 3830)， CIN 3研究7项(n = 245-351)。保守治疗CIN 1的女性总体回归、持续和进展到CIN 2或更坏和CIN 3或更坏的比率分别为60% (95% CI = 55-65, I2 = 92%)、25% (95% CI = 20-30, I2 = 94%)、11% (95% CI = 8-13, I2 = 89%)和2% (95% CI = 1-3, I2 = 82%)。CIN 2的总体回归率、持续率和进展率分别为55% (95% CI = 50-60, I2 = 85%)、23% (95% CI = 19-28, I2 = 83%)和19% (95% CI = 15-23, I2 = 88%)。最后，对于CIN 3，这些分别为28% (95% CI = 17-41, I2 = 68%)， 67% (95% CI = 36-91, I2 = 84%)和2% (95% CI = 0-25, I2 = 95%)。宫颈上皮内瘤变2级消退在30岁及以下女性和高危人乳头瘤病毒阴性女性中明显更高(66%，95% CI = 62-70, I2 = 76%;94%， 95% ci = 84-99, i2 = 60%)。仅2/ 7180(0.03%)和10/ 3037(0.3%)的CIN 1和CIN 2发展为宫颈癌。结论:大多数CIN 1/CIN 2会在不到24个月的时间内自发消退，在高危人乳头瘤病毒阴性和年轻女性中发生率最高，而进展为癌症的比例不到0.5%。应考虑保守治疗，特别是在育龄妇女和预期的高依从性。鉴于高级别组织学回归率的异质性，应将其分类为CIN 2或CIN 3以指导管理。

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来源期刊

Journal of Lower Genital Tract Disease OBSTETRICS & GYNECOLOGY-

CiteScore

6.80

自引率

8.10%

发文量

158

审稿时长

6-12 weeks

期刊介绍： The Journal of Lower Genital Tract Disease is the source for the latest science about benign and malignant conditions of the cervix, vagina, vulva, and anus. The Journal publishes peer-reviewed original research original research that addresses prevalence, causes, mechanisms, diagnosis, course, treatment, and prevention of lower genital tract disease. We publish clinical guidelines, position papers, cost-effectiveness analyses, narrative reviews, and systematic reviews, including meta-analyses. We also publish papers about research and reporting methods, opinions about controversial medical issues. Of particular note, we encourage material in any of the above mentioned categories that is related to improving patient care, avoiding medical errors, and comparative effectiveness research. We encourage publication of evidence-based guidelines, diagnostic and therapeutic algorithms, and decision aids. Original research and reviews may be sub-classified according to topic: cervix and HPV, vulva and vagina, perianal and anal, basic science, and education and learning. The scope and readership of the journal extend to several disciplines: gynecology, internal medicine, family practice, dermatology, physical therapy, pathology, sociology, psychology, anthropology, sex therapy, and pharmacology. The Journal of Lower Genital Tract Disease highlights needs for future research, and enhances health care. The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology, the International Society for the Study of Vulvovaginal Disease, and the International Federation of Cervical Pathology and Colposcopy, and sponsored by the Australian Society for Colposcopy and Cervical Pathology and the Society of Canadian Colposcopists.