Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy.

Abstract

OBJECTIVE:

The purpose of this study was to determine the risk of cumulative cervical intraepithelial neoplasia (CIN) grade 2 or 3 according to initial colposcopy and directed biopsy results among women with low-grade squamous intraepithelial lesions (LSIL) or human papillomavirus (HPV) DNA positive atypical squamous cells of undetermined significance (ASCUS).

STUDY DESIGN:

A 2-year follow-up of 897 cases of LSIL and 1193 cases of HPV DNA positive ASCUS from the ASCUS/LSIL Triage Study was used to simulate American Society for Colposcopy and Cervical Pathology Consensus Conference recommendations. Women with CIN grade 1 or less were followed up for 2 years by semiannual cytologic examination, with universal exit colposcopy. The clinical end point was a cumulative clinical center histologic diagnosis of CIN grade 2 or 3.

RESULTS:

The cumulative risk of CIN grade 2 or 3 was equivalent for LSIL (27.6%) and HPV positive ASCUS (26.7%). After excluding the women with a diagnosis of CIN grade 2 or 3 at initial colposcopy and directed biopsy (17.9%), the remaining women were at nearly identical risk for subsequent CIN grade 2 or 3 regardless of initial colposcopy result (completely negative colposcopy-11.3%; negative colposcopically directed biopsy-11.7%; and CIN grade 1 biopsy-13.0%).

CONCLUSION:

LSIL and HPV positive ASCUS are clinically equivalent. Initial colposcopic detection of obviously prevalent CIN grade 2 or 3 reduces risk. However, for the remaining women who have CIN grade 1 or less on colposcopy and directed biopsy, the risk for subsequent CIN grade 2 or 3 (whether missed, prevalent, or truly incident) is approximately 12% over 2 years. This risk does not vary meaningfully by initial distinction of histologic CIN grade 1 from negative colposcopy and biopsy.

• Authors: J Thomas Cox, Mark Schiffman, Diane Solomon, ASCUS-LSIL Triage Study (ALTS) Group
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 188 Issue 6 Pg. 1406-12 (Jun 2003) ISSN: 0002-9378 [Print] United States
• PMID: 12824970 (Publication Type: Journal Article, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• DNA, Viral

Topics

• Adolescent
• Adult
• Aged
• Biopsy
• Carcinoma, Squamous Cell (diagnosis, etiology, pathology, virology)
• Colposcopy
• DNA, Viral (genetics)
• Female
• Follow-Up Studies
• Humans
• Middle Aged
• Neoplasm Staging
• Papillomaviridae (genetics, isolation & purification)
• Prospective Studies
• Randomized Controlled Trials as Topic
• Risk Assessment
• Uterine Cervical Neoplasms (diagnosis, etiology, pathology, virology)
• Uterine Cervical Dysplasia (diagnosis, etiology, pathology, virology)