[Munich Nomenclature III: classification according to risk : Follow-up for conspicuous squamous findings]

Abstract

Aim: The present study evaluates the risk of progression of cytologic diagnoses which do not require immediate therapy but do need follow-up. The presented data can contribute to risk-adapted management strategies, according to Munich Nomenclature III.

Methods: Between January 2014 and March 2016, 3396 women were diagnosed as group II-p, IIID1, III-p, IIID2, IVa-p, IVb-p, and V‑p and represent the study population. Follow-up information on all subsequent cytologic and histologic findings were collected up to July 2017. For the initial cytologic diagnosis, the cumulative risk of CIN2+ or CIN3+ and the risk for persistent pathologic findings was calculated.

Results: The cumulative risk of CIN2+ for initial findings II-p, IIID1, III-p, and IIID2 is calculated as 7.3, 17.1, 46.3, and 62.4%, respectively, after a mean observation period of 24.4, 21.1, 15.6, and 14.3 months. The cumulative risk of CIN3+ (%) is determined as 5.0, 9.3, 37.6, and 45.8. For persistent cytologic diagnoses II-p, IIID1, III-p, and IIID2, the risk of CIN2+ increases significantly after the second result (0 to 3.6, 0.21 to 3.6, 7.2 to 58.3, and 8.1 to 64.7%). Risk of CIN2+ and CIN3+ for group III-p is significantly higher for women <35 years and <30 years compared with women of higher age. There are no significant age-dependent differences for findings II-p, IIID1, and IIID2.

Conclusions: The Munich Nomenclature III classifies cytologic findings according to risk. The diagnostic groups of the Munich Nomenclature III provide a solid basis for a risk-adapted clinical management, if the cytologic history of the individual patient is taken into account.

Keywords: CIN; Cervical cancer screening; Cervical cytology; Management strategies; Munich Nomenclature III.