Introduction/Background Cervical intraepithelial neoplasia (CIN) 2 in women younger than 24, observation is preferred in current treatment guidelines. In this study we evaluate the effectiveness of conservative management of CIN2 in Korean young women and find appropriate strategy considering age.
Methodology A total of 129 women ≤30 years diagnosed CIN2 on punch biopsy was retrospectively reviewed. Patient characteristics, initial and follow-up results of cervical examinations including pap smear, human papillomavirus (HPV), and punch biopsy were collected. Treatment was categorized into three: observation (n=30, 23.3%), ablation (n=15, 11.6%), and excision (n=84, 65.1%).
Recurrence was counted when high-grade lesions on pap smear or CIN1+ in biopsy were detected. Recurrence and recurrence-free survival (RFS) were compared. Survival analysis with Cox proportional hazards regression model was used.
Results Median age was 27 (range, 14-30). Excision group were older than the other groups (median, 28 vs. 26 years; p<0.001). Median follow-up was 16 months (range, 0-132 months). There were 14 recurrences (10.9%): 8 CIN1 and 6 CIN2. Observation group had more frequent recurrences (recurrence rate, 23.3% vs. 7.1%; p=0.019) than ablation or excision (treatment group) despite lower rate of HPV-16, 18 (+) (10.0% vs. 30.3%; p=0.026).
There was no difference in recurrence rate between ablation and excision throughout all age groups (6.7% vs. 7.1%). Observation (HR, 7.2; 95% CI, 2.0–26.0; p=0.003) and HPV 16, 18 (+) (HR, 4.4; 95% CI, 1.3–15.0; p=0.018) were independent factors for early recurrence. Age was not an independent factor. In patients ≤24 years, however, HPV 16, 18 (+) was the only independent factors for early recurrence (HR, 23.3; 95% CI, 1.9–285.3; p=0.014). In subgroup analyses of the other age criteria, observation was an independent factor.
Conclusion Observation increase early recurrence in women ≤30 years with CIN2. Ablation or careful follow-up could be appropriate in young women ≤24 years, which is consistent with guidelines of western countries.
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