Long-Term Follow-up of Young Women With High Grade Squamous Intraepithelial Lesions [1D]. (May 2016)

• Record Type: Journal Article
• Authors: Browning, Karen; Cronin, Beth; Palisoul, Marguerite; Kulkarni, Amita; Raker, Christina A.; Robison, Katina
• Is Part Of: Obstetrics and gynecology. Volume 127(2016)Supplement 1
• Publication Date: 2016-05
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1097/01.AOG.0000483379.16753.6c
• Languages: English
• ISSNs: 0029-7844

Abstract

Abstract : INTRODUCTION: Current cervical cancer screening guidelines allow for expectant management in lieu of excision for high-grade dysplasia in women under 25 years. Some practitioners worry about the safety of this practice. The objective of this study was to demonstrate the safety of expectant management in young women with high-grade dysplasia. METHODS: This was a retrospective cohort study of women under 25 years presenting to a resident clinic with high-grade cytology or histology between 1999 and 2012. Women were grouped by management category: expectant (EM) versus immediate excision (IE). RESULTS: 493 women met eligibility criteria. 417 were included in the primary analysis: 145 in the IE group and 272 in the EM group. The EM group underwent a mean of 0.2 excisional procedures compared to 1.1 in the IE group ( P =<.0001). Two years after initial presentation, 27.4% of women in the EM group and 3.5% of women in the IE group had CIN2+ histology. Of the 129 women expectantly managed with CIN2+ on initial biopsy, 79 (61.2%) showed regression, and 10 (7.8%) showed progression from CIN2 to CIN3. All regressions took place by year 5, with the majority (91%) by year 2. There were no cancer diagnoses at baseline or end of study period. CONCLUSION: Expectantly managed young women will have fewer excisional procedures over time. In this study, young women with high-grade dysplasia managed expectantly, showed regression 61% of the time and there were no progressions to cancer. Expectant management is safe for young women with high-grade cervical lesions.