Outcomes of Conservative Management of High Grade Squamous Intraepithelial Lesions in Young Women

Marette H Lee, Sarah J Finlayson, Ksenia Gukova, Gillian Hanley, Dianne Miller, Leslie Ann Sadownik, Marette H Lee, Sarah J Finlayson, Ksenia Gukova, Gillian Hanley, Dianne Miller, Leslie Ann Sadownik

Abstract

Objective: The aim of the study was to determine regression rates of cervical intraepithelial neoplasia (CIN) 2 and 3 in women younger than 24 years, followed conservatively for up to 24 months.

Materials and methods: This is a retrospective chart review of colposcopy patients in clinic database based on the following: (1) younger than 24 years at first visit; (2) first visit January 1, 2010, to May 31, 2013, and at least 1 follow-up visit after diagnosis; (3) histologic diagnosis of CIN2+; and (4) optimal conservative management (observation for up to 24 months or to 24 years, whichever occurred first). Patient information and clinical/pathologic data were extracted from charts to examine patient characteristics and treatment outcomes, CIN2+ regression rates, median times to regression for CIN2 versus CIN3 (Kaplan-Meier survival analysis), and predictors of regression (multivariate logistic regression analysis).

Results: A total of 154 women met criteria. The most severe histological diagnoses were CIN2 in 99 (64.3%), CIN3 in 51 (33.1%), and adenocarcinoma in situ in 4 (2.6%). Adenocarcinoma in situ was immediately treated. In follow-up, CIN2 regressed to CIN1 or negative in 74 women (74.7%)-median time to regression, 10.8 months. Cervical intraepithelial neoplasia 3 regressed in 11 women (21.6%)-median time to regression not reached (last follow-up censored at 52.7 months). Cervical intraepithelial neoplasia 2 on biopsy, low grade referral Pap, and younger age predicted regression. Overall, 49 women (31.8%) were treated.

Conclusions: Conservative management should continue to be recommended to young women with CIN2. Rigorous retention mechanisms are required to ensure that these women return for follow-up.

Figures

FIGURE 1
FIGURE 1
Histological outcomes of women

FIGURE 2

Kaplan-Meier analysis of CIN2 versus…

FIGURE 2

Kaplan-Meier analysis of CIN2 versus CIN3 lesion regression (1-survival) in women p <…24>

FIGURE 2
Kaplan-Meier analysis of CIN2 versus CIN3 lesion regression (1-survival) in women p < .0001.
FIGURE 2
FIGURE 2
Kaplan-Meier analysis of CIN2 versus CIN3 lesion regression (1-survival) in women p < .0001.

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