Risk stratification and conservative management of women aged 25-40 years with cervical intraepithelial neoplasia grade 2(CIN2).

Background: Cervical intraepithelial neoplasia grade 2 (CIN2) can progress to CIN3 or worse (CIN3⁺). Some patients diagnosed with CIN2 from a punch biopsy exhibit varied risks of occult CIN3⁺ in the loop electrosurgical excision procedure (LEEP) specimens following treatment, underscoring the need for risk stratification.

Methods: We conducted a retrospective observational study of 307 women aged ≤ 40 years, diagnosed with CIN2 via colposcopy-guided punch biopsy where the squamocolumnar junction was visible, and who underwent LEEP within three months. We compared the diagnoses from punch biopsies with the histology of the LEEP specimens and developed a stratified management algorithm based on identified risk factors.

Results: The risk of CIN3⁺ in the LEEP specimens for women aged 25-40 years was 24.9% (including one case of cervical microinvasive squamous cell carcinoma), significantly higher than in women under 25 years in univariate analysis (24.9% vs. 7.1%, P < 0.05). Multivariate analysis revealed HPV16/18 (OR 2.61, [95% CI 1.41-4.85]) and HSIL cytology (OR 4.14, [95% CI 2.03-8.47]) as independent risk factors.

Conclusion: Patients aged 25-40 years with CIN2 diagnosed in punch biopsy exhibited a substantial risk of CIN3⁺ in LEEP specimens, warranting consideration for surgical intervention, particularly in those with HPV16/18 and HSIL cytology. Approximately 30% of CIN2 patients with HPV16/18 and ASC-US/LSIL, or other high-risk HPV types and HSIL cytology, also showed CIN3⁺, suggesting that treatment should be individualized considering the patient's preferences and adherence. Conversely, the risk was low for those with HPV16/18 and normal cytology or other high-risk HPV types and ASC-US/LSIL, making conservative management a viable option. .