Conservative Management Outcome of Cervical Intraepithelial Neoplasia Grade 2: A Three-Year Follow-Up Study

Abstract

Background: This study aimed to evaluate the safety and outcomes associated with the conservative management of cervical intraepithelial neoplasia grade 2 (CIN2) in women by assessing the rates of spontaneous regression of CIN2, persistence of CIN2, or progression to CIN3 and cancer.

Methods: We conducted a retrospective cohort study at DGH Hospital in the UK. We examined the medical records using the Infoflex system of 146 women with histologically confirmed CIN2 between April 1, 2019, and April 30, 2022. These patients underwent regular follow-ups every 6 months, including colposcopy, repeated cervical smears/punch biopsy, and human papillomavirus (HPV) testing to monitor the progression or regression of their cervical lesions. The analysis included assessing the rates of spontaneous regression of CIN2, progression to CIN3 and cancer, the duration of conservative management, and the number of patients who defaulted on follow-up.

Results: Among the 146 women with histologically confirmed CIN2, only 67 patients were eligible for conservative management. All cases underwent thorough evaluation by a multidisciplinary team (MDT); and out of these 67 cases, nine cases were upgraded after MDT review: six based on histological findings (punch biopsies) from CIN2 to CIN3, and three based on upgraded cytological assessments resulting in a total of 56 cases suitable for CIN2 management. Out of these 56 women; 39 women were in the age group between 25 and 30 years; 15 women between 30 and 35 age group; one patient was 36 years, and one patient was 40 years old. Regression rate was 71% (n = 40/56) with conservative management; two cases progressed to CIN3 (had large loop excision of the transformation zone (LLETZ) procedure) with no progression to cancer. At 6, 12, 18, and 24 months, the number of negative smears were 27/56 (48%), 5/56 (8.9%), 2/56 (3.5%), and 1/56 (1.7%), respectively.

Conclusions: Contrary to prior studies (upper age limit < 30 years), our findings support successful (71% regression rate) conservative management (CIN2) in women aged 25 - 40 years. Additionally, our observations highlight the quicker resolution of cytological abnormalities compared to histological regression.

J Clin Gynecol Obstet. 2024;13(1):8-11
doi: https://doi.org/10.14740/jcgo936