Is watchful waiting a reasonable alternative to invasive treatment for 25- to 30-year-old women with cervical intraepithelial lesion grade 2?
For women aged 25 to 30 years old with biopsy-confirmed CIN2 and HPV type that is not 16, a large majority of lesions regress at least partially within 2 years without treatment. Watchful waiting may be appropriate. For women with HPV 16, only 51% had a partial or total regression of CIN2, suggesting that immediate treatment (LEEP) is warranted. The majority of progression or regression was evident at 12 months.
Plan de l'etude:
This was a Swedish multicenter cohort study to establish the natural course of cervical intraepithelial lesion grade 2 (CIN2) among patients aged 25 to 30 years at the time of diagnosis. The investigators included 137 patients with histological diagnosis of CIN2, fully visible squamocolumnar junction, transformation zone type 1 or 2, and available human papillomavirus (HPV) results within 3 months before biopsy. The authors excluded patients who were immunosuppressed, had a human immunodeficiency virus infection, were in cancer treatment, had previous treatment for CIN, or were pregnant at the time of diagnosis. The follow-up evaluation included colposcopy, cytology, HPV testing, and at least 2 cervical biopsies every 6 months for up to 24 months. Loop electrosurgical excision procedure (LEEP) was performed in cases with progression to CIN3+ or diagnosis of atypical glandular cells or adenocarcinoma in situ during the study period. LEEP was also performed at the conclusion of the study period for persistent CIN2. In cases of partial regression, patients were followed up until total regression. HPV testing identified HPV 16 and HPV 18 and 12 other strains as non-HPV 16/18. There were 10 patients who did not complete the protocol as planned, leaving 127 for the per-protocol analysis. Of these, 21% had been vaccinated for HPV, half before sexual debut. HPV types were non-HPV 16/18 in 72 patients (56%), HPV 16 in 45 (35%), HPV 18 in 4 (3%), and negative in 6 (5%). In the overall cohort, CIN2 regressed partially or totally in 68 of 82 (83%) patients with HPV status other than HPV 16, but only in 23 of 45 (51%) patients with HPV 16, a statistically significant difference (P = .0001). Only one patient (with HPV 16) had progression to stage 1A1 cervical cancer during the study period. Only one patient with HPV 16 had been vaccinated and the vaccination was after sexual debut.
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo