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Should Unsatisfactory Colposcopy Necessitate Treatment of Cervical Intraepithelial Neoplasia 1?

Day, Tania MD; Weitzen, Sherry PhD; Cooper, Amy S. CRNP; Boardman, Lori A. MD, ScM

Journal of Lower Genital Tract Disease: January 2008 - Volume 12 - Issue 1 - pp 11-15
doi: 10.1097/lgt.0b013e318057f330
Original Articles
Spanish Translation

Objective. To evaluate the prevalence of cervical intraepithelial neoplasia (CIN) 2 or worse among women undergoing cone biopsy for CIN 1, stratified by colposcopic adequacy.

Materials and Methods. A cross-sectional cohort study was performed using a colposcopic database of 3,004 women seen between August 1999 and December 2005. Data collected included demographic information, indications for treatment, adequacy of colposcopic examination, and final cone pathology. A satisfactory colposcopy was defined as being able to define the entire squamocolumnar junction and visualize all lesions in their entirety. Descriptive statistics and crude and adjusted odds ratios with 95% confidence intervals were calculated.

Results. Of the 440 cone biopsies, 50 (11%) were done for CIN 1, of which 9 (18%) demonstrated CIN 2 or worse, and 23 (46%) were done in the setting of unsatisfactory colposcopy. Compared with women with satisfactory colposcopy, women with unsatisfactory colposcopy were more likely to be older (median age = 33 vs 25 years, p = .01) and to have CIN 1 on endocervical sampling (5/22 [22%] vs 0, p < .01). Persistent (18 months or more) CIN 1 was more commonly encountered in women with satisfactory colposcopy (21/27 [78%] vs 7/23 [30%], p < .01). Women with unsatisfactory colposcopic examinations were at decreased risk of CIN 2+ on final pathology compared with women with satisfactory examinations (1/23 [4%] vs 8/27 [30%], odds ratios = 0.08, 95% confidence intervals = 0.01-0.95).

Conclusions. Women with unsatisfactory colposcopy and CIN 1 are unlikely to have high-grade cervical neoplasia on final pathology. For this subset of women, conservative management is preferable to immediate treatment.

Women with CIN1 and unsatisfactory colposcopy, currently recommended to undergo diagnostic excisional procedure, are unlikely to have highgrade cervical neoplasia on final cone pathology.

Department of Obstetrics and Gynecology, Women and Infants' Hospital of Rhode Island, Brown Medical School, Providence, RI

Reprint requests to: Lori A. Boardman, MD, ScM, Women and Infants' Hospital, Brown Medical School, 101 Dudley St, Providence RI 02905. E-mail: lboardman@wihri.org

This study was supported in part by a grant from the National Institute of Child Health and Human Development (K23 HD01307).

©2008The American Society for Colposcopy and Cervical Pathology