Advertisement

Archives of Gynecology and Obstetrics

, Volume 299, Issue 3, pp 841–846 | Cite as

Rates of regression of cervical dysplasia between initial biopsy and excisional procedure in routine clinical practice

  • Katrina MarkEmail author
  • Anja Frost
  • Heather Hussey
  • Micael Lopez-Acevedo
  • Anne E. Burke
  • Jill Edwardson
  • Opey Solaru
  • Patti Gravitt
Gynecologic Oncology
  • 102 Downloads

Abstract

Purpose

To determine rates and factors associated with regression of cervical intraepithelial neoplasia (CIN) 2 + between colposcopic biopsy and therapeutic excisional procedure in standard practice.

Methods

A retrospective chart review was performed for women undergoing a cervical excisional procedure for CIN 2 + at clinics at three academic institutions over a 3-year period. Cytology, histology, patient age and time-to-excision were analyzed to determine factors influencing rates of regression.

Results

Of 356 women undergoing excision for CIN 2 + on colposcopic biopsy, 91 (25.3%) of final pathology diagnoses displayed clinically significant regression. Age and time-to-excision were not associated with regression, but referral cytology and severity of initial biopsy histology were, with ASC-H (aOR 0.1, CI 0.03, 0.8) and CIN 3/AIS (aOR 0.4, CI 0.2, 0.7) being less likely to regress than less severe lesions.

Conclusions

Disease severity by referral cytology or diagnostic biopsy, as opposed to age or length of time-to-excision, is likely the most relevant factor in determination of regression for cervical intraepithelial neoplasia in women undergoing excisional treatment for biopsy-confirmed CIN2 +.

Keywords

Squamous intraepithelial lesions Human papillomavirus Spontaneous neoplasm regression Colposcopy Pap test 

Notes

Author contributions

KM: project development, data collection, manuscript writing. AF: project development, data collection, manuscript editing. HH: project development, data analysis. ML-A: project development, manuscript editing. AB: data collection, manuscript editing. JE: data collection. OS: data collection. PG: project development, data analysis, manuscript writing.

Funding

The authors have no funding to disclose.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.

References

  1. 1.
    National Cancer Institute (2018) SEER cancer stat facts: cervical cancer. https://seer.cancer.gov/statfacts/html/cervix.html. Accessed Mar 7 2018
  2. 2.
    Trimble CL, Piantadosi S, Gravitt P, Ronnett B, Pizer E, Elko A, Wilqus B, Yutzy W, Daniel R, Shah K, Peng S, Hung C, Roden R, Wu TC, Pardoll D (2005) Sponataneous regression of high-grade cervical dysplasia: effects of human papillomavirus type and HLA phenotype. Clin Cancer Res 11:4717–4723.  https://doi.org/10.1158/1078-0432.CCR-04-2599 CrossRefGoogle Scholar
  3. 3.
    Tainio K, Athanasiou A, Tikkinen K, Aaltonen R, Cardenas J, Hernandes Glazer-Livson S, Jakobsson M, Joronen K, Kiviharju M, Louvanto K, Oksjoki S, Tahtinen R, Virtanen S, Nieminen P, Kyrfiou M, Kalliala I (2018) Clincial course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ 27(360):k499.  https://doi.org/10.1136/bmj.k499 CrossRefGoogle Scholar
  4. 4.
    Melnikow J, Nuovo J, Willan A, Chan B, Howell L (1998) Natural history of cervical squamous intraepithelial lesions: a meta-analysis. Obstet Gynecol 92:727–735 (PMID:9764690)Google Scholar
  5. 5.
    Bjorge T, Skare GB, Bjorge L, Trope A, Lonnberg S (2016) Adverse pregnancy outcomes after treatment for cervical intraepithelial neoplasia. Obstet Gynecol 128:1265–1273.  https://doi.org/10.1097/AOG.0000000000001777 CrossRefGoogle Scholar
  6. 6.
    Sadler L, Saftlas A, Wang W, Exeter M, Whittaker J, McCowan L (2004) Treatment for cervical intraepithelial neoplasia and risk of preterm delivery. JAMA 291:2100–2106.  https://doi.org/10.1001/jama.291.17.2100 CrossRefGoogle Scholar
  7. 7.
    Samson SL, Bentley JR, Fahey TJ, McKay DJ, Gill GH (2005) The effect of loop electrosurgical excision procedure on future pregnancy outcome. Obstet Gynecol 105:325–332.  https://doi.org/10.1097/01.AOG.0000151991.09124.bb CrossRefGoogle Scholar
  8. 8.
    Kyrgiou M, Athanasiou A, Paraskevaidi M, Mitra A, Kalliala I, Martin-Hirsch P, Arbyn M, Bennett P, Paraskevaidis E (2016) Adverse obstetric outcomes after local treatment for cervical preinvasive and early invasive disease according to cone depth: systematic review and meta-analysis. BMJ 28(354):i3633.  https://doi.org/10.1136/bmj.i3633 CrossRefGoogle Scholar
  9. 9.
    Nasiell K, Nasiell M, Vaclavinkova V (1983) Behavior of moderate cervical dysplasia during long-term follow up. Obstet Gynecol 61:609–614 (PMID:6835614)Google Scholar
  10. 10.
    Ho G, Bierman R, Beardsley L, Chang C, Burk R (1998) Natural history of cervicovaginal papillomavirus infection in young women. N Engl J Med 338:423–428.  https://doi.org/10.1056/NEJM199802123380703 CrossRefGoogle Scholar
  11. 11.
    Katki H, Schiffman M, Castle P, Fetterman B, Poitras N, Lorey T, Cheung L, Raine-Bennett T, Gage J, Kinney W (2013) Estimating 5-year risk of CIN 3 + to guide the management of women aged 21–24. J Low Genit Tract Dis 17:S64–S68.  https://doi.org/10.1097/LGT.0b013e3182854399 CrossRefGoogle Scholar
  12. 12.
    Holowaty P, Miller A, Rohan T, To T (1999) Natural history of dysplasia of the uterine cervix. J Nat Can Inst 91(3):252–258 (PMID:10037103)CrossRefGoogle Scholar
  13. 13.
    Dalla Palma P, Giorgi Rossi P, Collina G, Buccoliero AM, Ghiringhello B, Gilioli E, Onnis GL, Aldovini D, Galanti G, Casadei G, Aldi M, Gomes VV, Giubilato P, Ronco G, NTCC Pathology Group (2009) The reproducibility of CIN diagnoses among different pathologists: data from histology reviews from a multicenter randomized study. Am J Clin Pathol 132(1):125–132.  https://doi.org/10.1309/ajcpbrk7d1yiuwfp CrossRefGoogle Scholar
  14. 14.
    Ismail S, Colclough A, Dinnen J, Eakins D, Evans DM, Gradwell E, O’Sullivan JP, SUmmerell JM, Newcombe RG (1989) Observer variation in histopathological diagnosis and grading cervical intraepithelial neoplasia. BMJ 298:707–710 (PMID:2496816)CrossRefGoogle Scholar
  15. 15.
    Castle P, Stoler M, Solomon D, Schiffman M (2007) The relationship of community biopsy-diagnosed cervical intraepithelial neoplasia grade 2 to the quality control pathology-reviewed diagnoses: an ALTS report. Am J Clin Pathol 127:805–815.  https://doi.org/10.1309/PT3PNC1QL2F4D2VL CrossRefGoogle Scholar
  16. 16.
    Carreon J, Sherman M, Guillen D, Solomon D, Herrero R, Jeronimo J, Wacholder S, Rodriguez AC, Morales J, Hutchinson M, Burk RD, Schiffman M (2007) CIN2 is a much less reproducible and less valid diagnosis than CIN3: results from a histological review of population based cervical samples. Int J Gynecol Pathol 26:441–446.  https://doi.org/10.1097/pgp.0b013e31805152ab CrossRefGoogle Scholar
  17. 17.
    Grimm C, Polterauer S, Natter C, Rahhal J, Hefler L, Tempfer CB, Heinze G, Stary G, Reinthaller A, Speiser P (2012) Treatment of cervical intraepithelial neoplasia with topical imiquomid: a randomized controlled trial. Obstet Gynecol 120:152–159.  https://doi.org/10.1097/AOG.0b013e31825bc6e8 CrossRefGoogle Scholar
  18. 18.
    Rader JS, Sill MW, Beume JH, Lankes HA, Benbrook DM, Garcia F, Trinble C, Tate Thigpen J, Lieberman R, Zuna RE, Leath CA, Spirtos NM, Byron J, Thaker PH, Lele S, Alberts D (2017) A stratified randomized double-blind phase II trial of celecoxib for treating patients with cervical intraepithelial neoplasia: the potential predictive value of VEGF serum levels: an NRG oncology/gynecologic oncology group study. Gynecol Oncol 145(2):291–297.  https://doi.org/10.1016/j.ygyno.2017.02.040 CrossRefGoogle Scholar
  19. 19.
    Massad L, Einstein M, Huh W, Katki H, Kinney W, Schiffman M, Solomon D, Wentzensen N, Lawson H, for the 2012 ASCCP consensus guidelines conference (2012) 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tact Dis 17:S1–S27.  https://doi.org/10.1097/LGT.0b013e318287d329 Google Scholar
  20. 20.
    Sykes P, Innes C, Harker D, Whitehead M, van der Griend R, Lawton B, Hibma M, Fitzergald P, Dudley N, Petrich S, Faherty J, Bergzoll C, Eva L, Parker C, Sadler L, Simcock B (2016) Observational management of CIN 2 in young women: a prospective multicenter trial. J Low Genit Tract Dis 20(4):343–347.  https://doi.org/10.1097/LGT.0000000000000244 CrossRefGoogle Scholar
  21. 21.
    Waxman A, Chelmow D, Darragh T, Herschel L, Moscicki A (2012) Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix. Obstet Gynecol 120:1465–1471.  https://doi.org/10.1097/AOG.0b013e31827001d5 CrossRefGoogle Scholar
  22. 22.
    Darragh T, Colgan T, Cox J, Heller D, Henry M, Luff R, McCalmont T, Nayar R, Palefsky JM, Stoler MH, Wilkinson EJ, Zaino RJ, Wilbur DC, Members of the LAST Project Work Groups (2012) The lower anogenital squamous terminology standardization project for HPV-associated pathologists and the american society for colposcopy and cervical pathology. J Low Genit Tract Dis 16:205–242.  https://doi.org/10.1097/lgt.0b013e31825c31dd CrossRefGoogle Scholar
  23. 23.
    Matthews T, Hamilton B (2016). Mean age of mothers on the rise: United States 2000–2014, centers for disease control and prevention, national center for health statistics. https://www.cdc.gov/nchs/products/databriefs/db232.htm. Accessed Feb 25 2018
  24. 24.
    Macdonald M, Smith JHF, Tidy JA, Palmer JE (2018) Conservative management of CIN2: national audit of British society for colposcopy and cervical pathology members’ opinion. J Obstet Gynaecol 6:1–7.  https://doi.org/10.1080/01443615.2017.1316973 Google Scholar
  25. 25.
    Smith HJ, Leath CA, Erickson BK (2016) See-and-treat for high grade cytology: do young women have different rates of high grade histology? J Low Genit Tract Dis 20:243–246.  https://doi.org/10.1097/LGT.0000000000000229 CrossRefGoogle Scholar
  26. 26.
    Stensen S, Sk Kjaer, Jensen SM, Frederiksen K, Junge J, Iftner T, Munk C (2016) Factors associated with type-specific persistence of high-risk human papillomavirus infection: a population-based study. Int J Cancer 138:361–368.  https://doi.org/10.1002/ijc.29719 CrossRefGoogle Scholar
  27. 27.
    Goodman MT, Shvetsov YB, McDuffie K, Wilkens LR, Zhu X, Thompson PJ, Ning L, Kileen J, Kamemoto L, Hernandez BY (2008) Prevalence, acquisition and clearance of cervical human papillomavirus infection among women with normal cytology: hawaii human papillomavirus cohort study. Cancer Res 68:8813–8824.  https://doi.org/10.1158/0008-5472 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Obstetrics, Gynecology and Reproductive SciencesUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Department of Gynecology and ObstetricsJohns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of Epidemiology and BiostatisticsThe George Washington UniversityWashingtonUSA
  4. 4.Division of Gynecologic OncologyThe George Washington University HospitalWashingtonUSA
  5. 5.Department of Global Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonUSA

Personalised recommendations