Development of evidence-based guidelines for follow up of women treated for cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) in Italian screening programmes
1Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
2Screening and Secondary prevention Unit, Institute for Cancer Research, Prevention and Clinical Network, 50139 Florence, Italy
3Department of Obstetrics and Gynecology, University Hospital, Via Aldo Moro, 8, 44124 Cona, Ferrara, Italy
DOI: 10.31083/j.ejgo4205157 Vol.42,Issue 5,October 2021 pp.1079-1092
Submitted: 26 April 2021 Accepted: 29 June 2021
Published: 15 October 2021
Background: The Italian Group for Cervical Cancer Screening (GISCi) promoted the update of recommendations for post Cervical Intraep-ithelial Neoplasia grade 2 or 3 (CIN2/3) treatment follow up. Methods: A multidisciplinary panel including all the professionals involved in cervical cancer screening and CIN treatment was set up. Systematic reviews have been conducted searching in PubMed. The GRADEpro online tool was used for: defining and prioritizing clinical questions framed in PICOs (Population Intervention Comparator Outcomes); defining and scoring outcomes as critical, important or not impor-tant; synthetizing results of the systematic reviews in Evidence to Decision tables and to grade recommendations. Results: A systematic review identified the main prognostic factors, but these have almost no impact in HPV-negative women. Six questions were prioritized for the first phase: 3 about the test (Pap, HPV-DNA or Pap + HPV co-testing or co-testing + colposcopy); 1 about the number of episodes before returning to screening; 2 about the timing of episodes. For the test accuracy direct evidence was available, while for other questions mostly indirect evidence was retrieved in systematic reviews. Conclusions: The panel recommends HPV test or co-testing (conditional either the two), but not Pap test as follow up test (strong). Colposcopy can be added to assess surgical outcomes (conditional either yes or not). Two episodes instead of one, before referring women to regular screening, should be preferred (conditional). The first episode should be 6 months (vs. 12) after treatment (strong), in order to avoid progression of undiagnosed prevalent invasive cancers; the interval between first and second episode may be either 6 or 12 months (conditional).
Cervical cancer; Cervical intraepithelial neoplasia (CIN) grade 2 or grade 3; Post-treatment follow up; Test of cure; Human papillomavirus; Guidelines; Evidence-based medicine
Paolo Giorgi Rossi,Anna Iossa,Carmen Beatriz Visioli,Francesco Venturelli,Paola Garutti. Development of evidence-based guidelines for follow up of women treated for cervical intraepithelial neoplasia grade 2 or 3 (CIN2/3) in Italian screening programmes. European Journal of Gynaecological Oncology. 2021. 42(5);1079-1092.
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