Predictors for regression and progression of actively surveilled cervical intraepithelial neoplasia grade 2: A prospective cohort study
Introduction To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance. Material and Methods This was a single‐center prospective observational cohort study. Women under 31 ...
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| Published in: | Acta obstetricia et gynecologica Scandinavica Vol. 104; no. 4; pp. 763 - 773 |
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| Main Authors: | , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
John Wiley & Sons, Inc
01.04.2025
John Wiley and Sons Inc Wiley |
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| ISSN: | 0001-6349, 1600-0412, 1600-0412 |
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| Abstract | Introduction
To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.
Material and Methods
This was a single‐center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).
Results
In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC‐US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40–6.69), and high‐grade referral cytology RR 4.73 (95% CI 1.18–19.03). Compared with baseline HPV negativity or having only low‐risk HPV genotypes present, high‐risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60–0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high‐risk HPV genotype, including HPV16, were not associated with the outcomes.
Conclusions
The majority of CIN2 lesions regress in young women. Women with large lesions and/or high‐grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression.
Over 60% of cervical intraepithelial neoplasia grade 2 lesions regress in young women. Lesion size and initial cytology can predict progression of cervical intraepithelial neoplasia grade 2. High‐risk HPV negativity at baseline increases the likelihood of regression. |
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| AbstractList | To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.
This was a single-center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).
In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC-US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40-6.69), and high-grade referral cytology RR 4.73 (95% CI 1.18-19.03). Compared with baseline HPV negativity or having only low-risk HPV genotypes present, high-risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60-0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high-risk HPV genotype, including HPV16, were not associated with the outcomes.
The majority of CIN2 lesions regress in young women. Women with large lesions and/or high-grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression. Abstract Introduction To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance. Material and Methods This was a single‐center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024). Results In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC‐US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40–6.69), and high‐grade referral cytology RR 4.73 (95% CI 1.18–19.03). Compared with baseline HPV negativity or having only low‐risk HPV genotypes present, high‐risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60–0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high‐risk HPV genotype, including HPV16, were not associated with the outcomes. Conclusions The majority of CIN2 lesions regress in young women. Women with large lesions and/or high‐grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression. Introduction To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance. Material and Methods This was a single‐center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024). Results In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC‐US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40–6.69), and high‐grade referral cytology RR 4.73 (95% CI 1.18–19.03). Compared with baseline HPV negativity or having only low‐risk HPV genotypes present, high‐risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60–0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high‐risk HPV genotype, including HPV16, were not associated with the outcomes. Conclusions The majority of CIN2 lesions regress in young women. Women with large lesions and/or high‐grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression. Over 60% of cervical intraepithelial neoplasia grade 2 lesions regress in young women. Lesion size and initial cytology can predict progression of cervical intraepithelial neoplasia grade 2. High‐risk HPV negativity at baseline increases the likelihood of regression. Over 60% of cervical intraepithelial neoplasia grade 2 lesions regress in young women. Lesion size and initial cytology can predict progression of cervical intraepithelial neoplasia grade 2. High‐risk HPV negativity at baseline increases the likelihood of regression. IntroductionTo evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.Material and MethodsThis was a single‐center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).ResultsIn total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC‐US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40–6.69), and high‐grade referral cytology RR 4.73 (95% CI 1.18–19.03). Compared with baseline HPV negativity or having only low‐risk HPV genotypes present, high‐risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60–0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high‐risk HPV genotype, including HPV16, were not associated with the outcomes.ConclusionsThe majority of CIN2 lesions regress in young women. Women with large lesions and/or high‐grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression. To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.INTRODUCTIONTo evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two years of active surveillance.This was a single-center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).MATERIAL AND METHODSThis was a single-center prospective observational cohort study. Women under 31 years of age giving written informed consent with histologically confirmed CIN2 were followed with colposcopy, cytology, and biopsies every 6 months up to 24 months. At baseline, HPV genotyping was performed on cervical samples. The rates of regression and progression were recorded for every timepoint and at the end of study overall and stratified according to clinical factors and HPV genotypes at baseline. Risk ratio (RR) was used to estimate the relative risks for regression and progression. The study was registered in the ISRCTN registry (ISRCTN91953024).In total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC-US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40-6.69), and high-grade referral cytology RR 4.73 (95% CI 1.18-19.03). Compared with baseline HPV negativity or having only low-risk HPV genotypes present, high-risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60-0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high-risk HPV genotype, including HPV16, were not associated with the outcomes.RESULTSIn total, 205/243 (84.4%) women completed the study. Complete regression (normal histology and/or normal or atypical squamous cells of undetermined significance (ASC-US) cytology) was detected in 64.4.% (n = 132) while 16.1% (n = 33) of the lesions progressed to CIN grade 3 (CIN3) or worse including 31 CIN3 cases, one adenocarcinoma in situ and one cervical cancer case. Factors associated with progression were initial large (>50% of the transformation zone) lesion size, risk ratio (RR) 3.06 (95% confidence interval (CI) 1.40-6.69), and high-grade referral cytology RR 4.73 (95% CI 1.18-19.03). Compared with baseline HPV negativity or having only low-risk HPV genotypes present, high-risk HPV (hrHPV) positivity was associated with lower likelihood of regression RR 0.74 (95% CI 0.60-0.91). Age, cigarette smoking, use of combined oral contraceptives or baseline high-risk HPV genotype, including HPV16, were not associated with the outcomes.The majority of CIN2 lesions regress in young women. Women with large lesions and/or high-grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression.CONCLUSIONSThe majority of CIN2 lesions regress in young women. Women with large lesions and/or high-grade referral cytology should perhaps more often be treated instead of active surveillance. Initial hrHPV genotype does not appear to predict outcomes while not harboring hrHPV favors regression. |
| Author | Bützow, Ralf Jakobsson, Maija Virtanen, Anni Aro, Karoliina Bergqvist, Laura Dillner, Joakim Kalliala, Ilkka Louvanto, Karolina Heinonen, Annu Nieminen, Pekka |
| AuthorAffiliation | 2 Department of Pathology University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital Helsinki Finland 3 Department of Metabolism, Digestion and Reproduction, Faculty of Medicine Institute of Reproductive and Developmental Biology, Imperial College London UK 5 Department of Obstetrics and Gynecology Tampere University Hospital Tampere Finland 6 Department of Obstetrics and Gynecology, Faculty of Medicine and Health Technology Tampere University Tampere Finland 1 Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital Helsinki Finland 7 Department of Laboratory Medicine Karolinska Institute Stockholm Sweden 4 Department of Obstetrics and Gynecology Hyvinkää Hospital, Helsinki University Hospital and University of Helsinki Hyvinkää Finland |
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| Keywords | colposcopy cervical intraepithelial neoplasia grade 2 (CIN2) cervical cytology HPV genotype active surveillance large loop excision of the transformation zone (LLETZ) |
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To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women... To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women during two... IntroductionTo evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in young women... Over 60% of cervical intraepithelial neoplasia grade 2 lesions regress in young women. Lesion size and initial cytology can predict progression of cervical... Abstract Introduction To evaluate predicting clinical factors for regression and progression of cervical intraepithelial neoplasia (CIN) grade 2 (CIN2) in... |
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| SubjectTerms | active surveillance Adult Cellular biology cervical cytology cervical intraepithelial neoplasia grade 2 (CIN2) Cohort analysis Colposcopy Disease Progression Female Genotype Gynecology HPV genotype Human papillomavirus Humans large loop excision of the transformation zone (LLETZ) Neoplasm Grading Original Research Papillomaviridae - genetics Papillomavirus Infections - pathology Prospective Studies Surveillance Uterine Cervical Dysplasia - pathology Uterine Cervical Dysplasia - virology Uterine Cervical Neoplasms - pathology Uterine Cervical Neoplasms - virology Watchful Waiting Young Adult |
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| Title | Predictors for regression and progression of actively surveilled cervical intraepithelial neoplasia grade 2: A prospective cohort study |
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