Association between grade of referral smear and high‐grade disease among women with biopsy samples showing cervical intraepithelial neoplasia grade 2. Issue 2 (9th November 2017)

• Record Type: Journal Article
• Authors: Hakem, Emmanuel; Ibrahim, Elzahra; Tanyous, Emmanuel; Astbury, Katharine; Purandare, Nikhil
• Is Part Of: International journal of gynaecology and obstetrics. Volume 140:Issue 2(2018)
• Page Start: 223
• Page End: 227
• Publication Date: 2017-11-09
• Subjects: Cervical intraepithelial neoplasia -- Dysplasia -- Large loop excision of the transformation zone -- Neoplasia -- Preterm labor; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.12357
• Languages: English
• ISSNs: 0020-7292

Abstract

Abstract: Objective: To determine whether the grade of referral smear reflects the frequency of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or worse lesions among patients with CIN2 on punch biopsy. Methods: In a retrospective study, data were reviewed from women with a punch biopsy sample showing CIN2 and a known referral smear who underwent large loop excision of the transformation zone (LLETZ) between January 1, 2013, and January 1, 2016, at Galway University Hospital, Ireland. Data were analyzed by patient age (≤30 and >30 years), referral smear (low and high grade), and LLETZ histology (≤CIN2 and ≥CIN3). Results: Overall, 264 women were included. LLETZ histology of CIN3 or worse was more common among women with high‐grade referral smears (63/144 [43.8%]) than among those with low‐grade smears (26/120 [21.7%]; relative risk 2.02, 95% confidence interval 1.37–2.96; P< 0.001). Among patients younger than 30 years, underlying CIN3 and above was again more frequent among women with high‐grade (44/95 [46.3%]) versus low‐grade smears (12/56 [21.4%]; relative risk 2.16, 95% confidence interval 1.25–3.73; P= 0.004). No difference was recorded in the older age group. Conclusion: Although LLETZ can be performed for a CIN2 biopsy and high‐grade smear, consideration should be given among young women (<30 years) with low‐grade smears whose biopsy histology is incidentally CIN2. Abstract : Consideration should be given before performing large loop excision on a young woman (<30 years) with a low‐grade smear whose histology is incidentally CIN2.