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The progression rate is low for cervical intraepithelial neoplasia grade 2
Clinical Question
What is the rate of progression of untreated cervical intraepithelial neoplasia grade 2?
Bottom line
Buried in US guidelines for the management of abnormal cervical cancer screening resuls is a note that observation is preferred for women younger than 24 years with cervical intraepithelial neoplasia grade 2 (CIN2) (https://goo.gl/L71Jhr). This study may lead us to increase the use of surveillance rather than treatment for women with an initial finding of CIN2, since less than 20% of the lesions will progress over the subsequent 2 years. 1a
Reference
Study design: Meta-analysis (other)
Funding: Industry
Setting: Various (meta-analysis)
Synopsis
These authors searched 3 databases and found 36 studies of 3160 nonpregnant women with confirmed CIN2 who were managed conservatively (ie, did not begin treatment) for 3 or more months. Two reviewers independently performed the literature review, extracted the data from the studies, and assessed for risk of bias. By 24 months, 50% of untreated women (11 studies, n = 1470) regressed to either normal or with atypical squamous cells of unknown significance, and/or low-grade squamous cervical intraepithelial lesion; 32% (8 studies, n = 1257) had persistent CIN2; and 18% (9 studies, n = 1445) progressed. The rate of regression was higher in women younger than 30 years (60%). There was a high level of heterogeneity among all studies for all outcomes that could not be accounted for.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
what after two years ?
Cervical intraepithelial neoplasia
Small study group with inconclusive evidence over a two year period, the more concerning outcome of 32% with persistent changes which did not regress to normal.
I suspect a large number of patients can be lost to follow-up surveillance if not referred for treatment right away when diagnosed with CIN 2. Perhaps only on the subgroup of patients who can be reliably followed may fit into the "observation" plan.
Good poem
I will still be following current guidelines for referral to colposcopy however look forward to perhaps less treatment for such patients in the future if that is indicated.