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Abstract
Introduction/Background*Cervical intraepithelial neoplasia (CIN) grade 2 is classified as high-grade intraepithelial lesion (HSIL) due to its potential for developing cancer. Persistent human papillomavirus (HPV) infection is an established risk factors to develop cervical cancer and its precursor lesions. The management of CIN2 remains under discussion, spontaneous progression and regression rates are around 11-18% and 50-61% respectively at 24 months of follow-up. The purpose of this study was to evaluate the role of HPV genotyping and previous cytology result to predict the evolutions of CIN2 managed conservatively.
Methodology A prospective observational study was conducted at Hospital del Mar in Barcelona from January 2012 to May 2017. Women with new diagnosis of CIN2 were invited to undergo conservative management for 24 months. Complete regression, partial regression, persistence, and progression to CIN3 were defined as final outcomes.
Result(s)*291 of the 300 included patients completed the 24-months follow-up. Of them, 214 patients (73.5%) showed regression; 43 (14.8%) persistence of CIN2, and 34 (11.7%) progression to CIN3. In multivariable analysis, HPV-16 infection (odds ratio [OR] 1.97 [95% confidence interval {CI} 1.13-3.43]) and previous cytology (OR 3.46, 95% CI 1.99-6.02) significantly increased the risk of persistence or progression of CIN2 lesions (CIN2+). All HPV-negative lesions regressed (p<0.001). According to patients’ age, no significant differences between age at diagnosis and final diagnosis were found.
Conclusion*The regression rate of CIN2 lesions supports conservative management in selected patients regardless of their age. Patients with CIN2 biopsy and negative HPV test had a high rate of regression and should be offered follow-up without excisional treatment. Women with HPV-16 and HSIL cytology had an increased risk of CIN2+, their treatment should be individualized, and excisional treatment should be considered.