Walter Kinney1, William C Hunt2, Helen Dinkelspiel3, Michael Robertson2, Jack Cuzick4, Cosette M Wheeler5. 1. Department of Women's Health and Division of Gynecologic Oncology, The Permanente Medical Group, Oakland, CA, USA. 2. Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. 3. Division of Gynecologic Oncology, Columbia University College of Physicians and Surgeons, New York, NY, USA. 4. Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK. 5. Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. Electronic address: cwheeler@salud.unm.edu.
Abstract
OBJECTIVE: Assessment of cytology and biopsy results preceding cervical excisional treatment and their association with excisional histology, to evaluate compliance with treatment recommendations and the potential effect of revisions in cervical histology terminology and usage. METHOD: Data from a unique statewide population-based screening registry was used to describe the use and histologic outcomes of cervical excisional procedures in the year following an abnormal cervical screening cytology. RESULTS: From 2007 to 2011, LEEP rates decreased 87%, 45%, and 16% for women aged 15-20, 21-24, and 25-29 years, respectively. Reductions were attributable to an overall decline in cervical screening and colposcopy, and a decrease in LEEP following a diagnosis of less than cervical intraepithelial neoplasia grade 2 (<CIN2) or CIN2 histology preceded by any abnormal cytology other than high-grade squamous intraepithelial lesion (<HSIL). LEEP rates did not change significantly (p>0.7) for women aged 30-39 years. Irrespective of age, CIN2 was the most common histologic antecedent of excisional treatment (42%), with most (80%) preceded by <HSIL cytology. CONCLUSION: Cervical excisions are an unavoidable consequence of cervical screening. Adherence to treatment guidelines stipulating conservative follow-up of young women with biopsies ≤CIN2 could significantly decrease the number of excisional procedures and associated harms. This opportunity will be lost if cervical intraepithelial neoplasia grade 3 (CIN3) and some or all of CIN2 are merged into a single histologic category, as has been recently recommended in the United States.
OBJECTIVE: Assessment of cytology and biopsy results preceding cervical excisional treatment and their association with excisional histology, to evaluate compliance with treatment recommendations and the potential effect of revisions in cervical histology terminology and usage. METHOD: Data from a unique statewide population-based screening registry was used to describe the use and histologic outcomes of cervical excisional procedures in the year following an abnormal cervical screening cytology. RESULTS: From 2007 to 2011, LEEP rates decreased 87%, 45%, and 16% for women aged 15-20, 21-24, and 25-29 years, respectively. Reductions were attributable to an overall decline in cervical screening and colposcopy, and a decrease in LEEP following a diagnosis of less than cervical intraepithelial neoplasia grade 2 (<CIN2) or CIN2 histology preceded by any abnormal cytology other than high-grade squamous intraepithelial lesion (<HSIL). LEEP rates did not change significantly (p>0.7) for women aged 30-39 years. Irrespective of age, CIN2 was the most common histologic antecedent of excisional treatment (42%), with most (80%) preceded by <HSIL cytology. CONCLUSION: Cervical excisions are an unavoidable consequence of cervical screening. Adherence to treatment guidelines stipulating conservative follow-up of young women with biopsies ≤CIN2 could significantly decrease the number of excisional procedures and associated harms. This opportunity will be lost if cervical intraepithelial neoplasia grade 3 (CIN3) and some or all of CIN2 are merged into a single histologic category, as has been recently recommended in the United States.
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