Comparison of Expectant and Excisional/Ablative Management of Cervical Intraepithelial Neoplasia Grade 2 (CIN2) in the Era of HPV Testing

IF 1.6 Q3 OBSTETRICS & GYNECOLOGY
K. Tjandraprawira, A. Olaitan, A. Petrie, N. Wilkinson, A. Rosenthal
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引用次数: 2

Abstract

Objective To investigate conservative and excisional/ablative treatment outcomes for cervical intraepithelial neoplasia grade 2 (CIN2) following introduction of virological test of cure. Methods This was a retrospective study of prospectively collected data at a teaching hospital colposcopy unit. 331 sequential biopsy-proved CIN2 cases were involved. CIN2 cases diagnosed between 01/07/2014 and 31/12/2017 were either conservatively managed or treated with excision/ablation and then were followed up until discharge from colposcopy clinic and then using the national cervical cytology database. Outcomes were defined: cytological/histological regression was absence of high-grade CIN on biopsy and/or high-grade dysplasia; virological regression was cytological/histological regression and negative human papillomavirus testing; persistence was biopsy-proven CIN2 and/or moderate dyskaryosis; progression was biopsy-proven CIN3+ and/or severe dyskaryosis. Results Median follow-up was 22.6 months (range: 1.9–65.1 months). Among 175 (52.9%) patients initially managed conservatively, 77.3% (133/172) regressed, 13.4% (23/172) persisted, 9.3% (16/172) progressed to CIN3+, and 97 (56.4%) patients achieved virological regression. 156 (47.1%) patients underwent initial excision/ablation, with an 89.4% (110/123) virological cure rate. After discharge, 7 (4.0%) and 3 (1.9%) patients redeveloped CIN in the conservative and treatment groups, respectively, during a median period of 17.2 months. Conclusion Conservative management is a reasonable and effective management strategy in appropriately selected women with CIN2. High rates of histological and virological regression should be expected. The previously mentioned data provide useful information for deciding management options.
HPV检测时代宫颈上皮内瘤变2级(CIN2)的预期治疗与切除/消融治疗的比较
目的探讨宫颈上皮内瘤变2级(CIN2)引入病毒学治疗后的保守和切除/消融治疗效果。方法回顾性分析某教学医院阴道镜检查科室的前瞻性资料。331例经序贯活检证实为CIN2。2014年7月1日至2017年12月31日诊断的CIN2例患者,要么保守治疗,要么切除/消融治疗,然后随访至阴道镜诊所出院,然后使用国家宫颈细胞学数据库。结果被定义为:细胞学/组织学倒退是活检中没有高级别CIN和/或高级别不典型增生;病毒学消退为细胞学/组织学消退和人乳头瘤病毒检测阴性;活检证实持续存在CIN2和/或中度核发育不良;活检证实CIN3+和/或严重核发育不良。结果中位随访时间为22.6个月(范围1.9 ~ 65.1个月)。175例(52.9%)患者最初采用保守治疗,77.3%(133/172)患者病情好转,13.4%(23/172)患者持续,9.3%(16/172)进展为CIN3+, 97例(56.4%)患者病毒学好转。156例(47.1%)患者接受了初始切除/消融治疗,病毒学治愈率为89.4%(110/123)。出院后,保守组和治疗组分别有7例(4.0%)和3例(1.9%)患者再次发生CIN,中位时间为17.2个月。结论选择合适的CIN2患者,保守治疗是合理有效的治疗策略。高的组织学和病毒学退化率是可以预料的。前面提到的数据为决定管理方案提供了有用的信息。
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来源期刊
Obstetrics and Gynecology International
Obstetrics and Gynecology International OBSTETRICS & GYNECOLOGY-
CiteScore
3.60
自引率
0.00%
发文量
26
审稿时长
19 weeks
期刊介绍: Obstetrics and Gynecology International is a peer-reviewed, Open Access journal that aims to provide a forum for scientists and clinical professionals working in obstetrics and gynecology. The journal publishes original research articles, review articles, and clinical studies related to obstetrics, maternal-fetal medicine, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine and infertility, reproductive endocrinology, and sexual medicine.
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