Frequency of recurrence after surgical treatment of cervical intraepithelial neoplasia grade 1-3

Purpose of investigation: The objective was to demonstrate the frequency of invasive cervical cancer or recurrent CIN in patients treated by a previous diagnosis of CIN 1-3. Methods: We analyzed 1,397 records colpocytologic and medical records. Recurrence of CIN or invasive neoplasia of the cervix after treatment of CIN was assessed. The chi-square test was used for statistical analysis (significance level set at less than 0.05). Results: We obtained 696 CIN 1, 244 CIN 2, 451 CIN 3, and six squamous carcinoma. Regarding patients who relapsed, there were 6/690 (0.9%) patients had an initial diagnosis of CIN 1, 8/236 (3.4%) CIN 2 and 21/430 (4.9%) CIN 3 (p < 0.0001). Comparing the frequency of relapse among each group, we found: CIN 1 vs CIN 2: p = 0.0073; CIN 1 vs CIN 3: p < 0.0001; CIN 2 vs CIN 3: p = 0.38. Conclusion: Although the number of relapses when comparing CIN 2 and CIN 3 were not significant, the data suggest that CIN 2 has lower recurrence rates, so these patients require more conservative treatment if a desire of future pregnancy is expressed.

Post-treatment recurrence; Cervical intraepithelial neoplasia; Invasive cervical cancer

[1] Smith R.A., Cokkinides V., Brawley O.W.: “Cancer screening in the United States, 2008: a review of current American cancer society guidelines and cancer screening issues”. CA Cancer J. Clin., 2008, 58, 161.

[2] Melnikow J., McGahan C., Sawaya G.F., Ehlen T., Coldman A.: “Cervical intraepithelial neoplasia outcomes after treatment: longterm follow-up from the British Columbia Cohort Study”. J. Natl. Cancer Inst., 2009, 101, 721.

[3] Martin-Hirsch P.P., Paraskevaidis E., Bryant A., Dickinson H.O., Keep S.L.: “Surgery for cervical intraepithelial neoplasia”. Cochrane Database Syst. Rev., 2010, 16, CD001318.

[4] ACOG Practice Bulletin No. 99: “Management of abnormal cervical cytology and histology. American College of Obstetricians and Gynecologists”. Obstet. Gynecol., 2008, 112, 1419.

[5] Wright T.C. Jr., Massad L.S., Dunton C.J., Spitzer M., Wilkinson E.J., Solomon D., 2006 American Society for Colposcopy and Cervical Pathology-sponsored Consensus Conference: “2006 consensus guidelines for the management of women with cervical intraepithelial neoplasia or adenocarcinoma in situ”. J. Low Genit. Tract. Dis. 2007, 11, 223.

[6] McCredie M.R., Sharples K.J., Paul C., Baranyai J., Mendley G., Jones R.W., Skegg D.C.: “Natural history of cervical neoplasia and risk of invasive cancer in women with cervical intraepithelial neoplasia 3: a retrospective cohort study”. Lancet Oncol. 2008, 9, 425.

[7] Lindeque B.G.: “Management of cervical premalignant lesions”. Best. Pract. Res. Clin. Obstet. Gynaecol., 2005, 19, 545.

[8] Cox J.T., Schiffman M., Solomon D.: “Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grad 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy”. Am. J. Obstet. Gynecol., 2003, 188, 1406.

[9] Alonso I., Torné A., Puig-Tintoré L.M., Esteve R., Quinto L., Campo E. et al.: “Pre- and post-conization high-risk HPV testing predicts residual/recurrent disease in patients treated for CIN 2-3”. Gynecol. Oncol., 2006, 103, 631.

[10] Jeong N.H., Lee N.W., Kim H.J., Kim T., Lee K.W.: “High-risk human papillomavirus testing for monitoring patients treated for high-grade cervical intraepithelial neoplasia”. J. Obstet. Gynaecol. Res., 2009, 35, 706.

[11] Ribaldone R., Boldorini R., Capuano A. et al.: “Role of HPV testing in the follow-up of women treated for cervical dysplasia”. Arch. Gynecol. Obstet., 2010, 282, 193.

[12] Armarnik S., Sheiner E., Piura B., Meirovitz M., ZlotnikA., Levy A. et al.: “Obstetric outcome following cervical conization”. Arch. Gynecol. Obstet., 2011, 283, 765.

[13] Prendiville W.: “The treatment of CIN: what are the risks?”. Cytopathology, 2009, 20, 145.

[14] Sjøborg K.D., Vistad I., Myhr S.S., Svenningsen R., Herzoq C., Kloster-Jensen A. et al.: “Pregnancy outcome after cervical cone excision: a case-control study”. Acta Obstet. Gynecol. Scand., 2007, 86, 423.

[15] Samson S.L., Bentley J.R., Fahey T.J., McKay D.J., Gill G.H.: “The effect of loop electrosurgical excision procedure on future pregnancy outcome”. Obstet. Gynecol., 2005, 105, 325.

[16] Sadler L., Saftlas A., Wang W., Exeter M., Whittaker J., McCowan L.: “Treatment for cervical intraepithelial neoplasia and risk of preterm delivery”. JAMA, 2004, 291, 2100.

[17] Michelin M.A., Merino L.M., Franco C.A., Murta E.F.: “Pregnancy outcome after treatment of cervical intraepithelial neoplasia by the loop electrosurgical excision procedure and cold knife conization”. Clin. Exp. Obstet. Gynecol., 2009, 36, 17.

[18] Syrjänen K.J.: “Spontaneous evolution of intraepithelial lesions according to the grade and type of the implicated human papillomavirus (HPV)”. Eur. J. Obstet. Gynecol. Reprod. Biol., 1996, 65, 45.

[19] Ostor A.G.: “Natural history of cervical intraepithelial neoplasia: a critical review”. Int. J. Gynecol. Pathol., 1993, 12, 186.

[20] Castle P.E., Schiffman M., Wheeler C.M., Solomon D.: “Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2”. Obstet. Gynecol., 2009, 113, 18. Address