A prospective cohort study of the conservative management of focal cervical intraepithelial neoplasia 2

Abstract

Background and Purpose: Traditionally, cervical intraepithelial neoplasia 2 (CIN 2) is managed by the removal of affected tissue in a procedure known as a large loop excision of the transformation zone (LLETZ). In our unit, pathology reports on LLETZ specimens done for a diagnosis of CIN 2 often are reported as CIN 1 or a normal result. So we wondered – are we over-managing CIN 2?
Methods: This study was designed to assess the acceptability and outcomes of the conservative management of focal CIN 2. We wanted to establish if monitoring of the disease is sufficient in selected women. In this prospective cohort, women were selected for inclusion in the study by having a histological diagnosis of focal CIN 2 from a cervical biopsy and after discussion at the colposcopy multi-disciplinary team meeting. After explanation of CIN 2 and its future implications, women were informed of the risks and benefits of conservative management versus LLETZ. Women who opted for conservative management were seen in the colposcopy clinic for colposcopy examination, cervical biopsy ± cervical smear and HPV testing at six monthly intervals for two years.
Results: Over the two-year follow-up period, 20/31 women (64.5%) had regression of disease, 7/31 women (22.6%) had persistence of CIN 2 and 4/31 women (12.9%) had progression of disease to CIN 3. There were no reported cases of cervical carcinoma in situ or invasive cervical carcinoma. During the follow-up period, patients were offered treatment if there was progression to CIN 3 or worse, persistence of CIN 2 or if they wished to undergo treatment at any stage.
Conclusions: Conservative management of CIN 2 may be considered in women who are under the age of 30 with focal CIN 2. However, larger studies should be carried out to define the safety or acceptability of changing this practice.

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