Management of women with low grade cytology: how reassuring is a normal colposcopy examination?. (20th June 2014)

• Record Type: Journal Article
• Authors: Cruickshank, ME; Cotton, SC; Sharp, L; Smart, L; Walker, LG; Little, J; the TOMBOLA Group
• Is Part Of: BJOG. Volume 122:Number 3(2015:Mar.)
• Page Start: 380
• Page End: 386
• Publication Date: 2014-06-20
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12932
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12932-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12932-sec-0001" sec-type="section"> <title>Objectives</title> <p>To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow‐up.</p> </sec> <sec id="bjo12932-sec-0002" sec-type="section"> <title>Design</title> <p>Cohort study within a randomised controlled trial.</p> </sec> <sec id="bjo12932-sec-0003" sec-type="section"> <title>Setting</title> <p>NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.</p> </sec> <sec id="bjo12932-sec-0004" sec-type="section"> <title>Population</title> <p>Eight hundred and eighty‐four women aged 20–59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.</p> </sec> <sec id="bjo12932-sec-0005" sec-type="section"> <title>Methods</title> <p>Samples at baseline were tested for 14 high‐risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type‐specific primers. Women were followed up post‐colposcopy by cervical cytology at 6‐month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.</p> </sec> <sec id="bjo12932-sec-0006" sec-type="section"> <title>Main outcome measures</title> <p>Absolute and relative risks of CIN2+ during follow‐up and/or at exit colposcopy.</p> </sec> <sec id="bjo12932-sec-0007" sec-type="section"> <title>Results</title> <p>The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV‐positive (RR 5.86, 95% confidence interval 2.53–13.56) compared with women with BNA who were HrHPV‐negative.</p> </sec> <sec id="bjo12932-sec-0008" sec-type="section"> <title>Conclusion</title> <p>For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3‐year recall.</p> </sec> </abstract>