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. 2014 Mar;132(3):628-35.
doi: 10.1016/j.ygyno.2013.12.037. Epub 2014 Jan 4.

Cervical excisional treatment of young women: a population-based study

Walter Kinney  1 , William C Hunt  2 , Helen Dinkelspiel  3 , Michael Robertson  2 , Jack Cuzick  4 , Cosette M Wheeler  5 ; New Mexico HPV Pap Registry Steering Committee
Collaborators, Affiliations

Cervical excisional treatment of young women: a population-based study

Walter Kinney et al. Gynecol Oncol. 2014 Mar.

Abstract

Objective: Assessment of cytology and biopsy results preceding cervical excisional treatment and their association with excisional histology, to evaluate compliance with treatment recommendations and the potential effect of revisions in cervical histology terminology and usage.

Method: Data from a unique statewide population-based screening registry was used to describe the use and histologic outcomes of cervical excisional procedures in the year following an abnormal cervical screening cytology.

Results: From 2007 to 2011, LEEP rates decreased 87%, 45%, and 16% for women aged 15-20, 21-24, and 25-29 years, respectively. Reductions were attributable to an overall decline in cervical screening and colposcopy, and a decrease in LEEP following a diagnosis of less than cervical intraepithelial neoplasia grade 2 (<CIN2) or CIN2 histology preceded by any abnormal cytology other than high-grade squamous intraepithelial lesion (<HSIL). LEEP rates did not change significantly (p>0.7) for women aged 30-39 years. Irrespective of age, CIN2 was the most common histologic antecedent of excisional treatment (42%), with most (80%) preceded by <HSIL cytology.

Conclusion: Cervical excisions are an unavoidable consequence of cervical screening. Adherence to treatment guidelines stipulating conservative follow-up of young women with biopsies ≤CIN2 could significantly decrease the number of excisional procedures and associated harms. This opportunity will be lost if cervical intraepithelial neoplasia grade 3 (CIN3) and some or all of CIN2 are merged into a single histologic category, as has been recently recommended in the United States.

Keywords: Adherence to cervical treatment guidelines; Cervical intraepithelial neoplasia grades 2 and 3 (CIN2 and CIN3); Cervical screening; Colposcopy; Effectiveness and harms of cervical screening; Loop electrosurgical excision procedure (LEEP).

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Conflict of interest statement

Conflicts of Interest Statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
(A) Percent of women with colposcopic biopsy or endocervical curettage (ECC) within 12 months of abnormal index screening cytology by age of woman and result of cytology. Cytology results are classified as ASC-US [atypical squamous cells of undetermined significance, negative for high-risk human papillomavirus (HPV) or HPV status unknown], ASC-US+ [ASC-US, positive for high-risk HPV], LSIL [low-grade squamous intraepithelial lesion], ASC-H [atypical squamous cells-cannot rule out high-grade], and HSIL [high-grade squamous intraepithelial lesion].
Figure 2
Figure 2
(A). Percent of women with colposcopic biopsy or endocervical curettage (ECC) within 12 month of index screening cytology with result of ASC-US+ [atypical squamous cells of unknown significance, high-risk human papillomavirus (HPV) positive] or more severe by age of woman and year of cytology. (B). Percent of women receiving excisional treatment (LEEP) following colposcopic biopsy or endocervical curettage (ECC) with diagnosis of negative, cervical intraepithelial neoplasia grade 1 (CIN1), or cervical intraepithelial neoplasia grade 2 (CIN2) accompanied by less than high-grade squamous intraepithelial lesion (
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