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Journal of Lower Genital Tract Disease:
doi: 10.1097/LGT.0b013e3182a1772c
Original Articles

Postcolposcopy Management of Women With Histologically Proven CIN 1: Results From TOMBOLA

Gurumurthy, Mahalakshmi MRCOG1; Cotton, Seonaidh C. BSc, MLitt, PhD2; Sharp, Linda BSc(Hons), MSc, PhD3; Smart, Louise MD, FRCPath4; Little, Julian MA PhD5; Waugh, Norman MCRP(UK), MPH, FFPHM6; Cruickshank, Margaret E. MD, FRCOG2

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Objectives: This study aimed to determine during 36 months of follow-up the (1) clinical outcomes and (2) influence of high-risk human papillomavirus (HPV) status on the risk of progression to cervical intraepithelial neoplasia 2+ (CIN 2+), among women with histologically proven CIN 1.

Materials and Methods: This is an ad hoc analysis of women with CIN 1 within TOMBOLA, a randomized trial of the management of women with low-grade cervical cytology. Women from the colposcopy arm with CIN 1 confirmed on punch biopsies and managed conservatively by cytology every 6 months in primary care were included. Sociodemographic data and a sample for HPV testing were collected at recruitment. Data on the sample women were extracted to calculate the cumulative incidence of CIN 2+ and the performance characteristics of the baseline HPV test. Detection of CIN 2 or worse (CIN 2+) during follow-up or at exit colposcopy was analyzed.

Results: A total of 171 women were included. Their median age was 29 years. Fifty-two percent were high-risk HPV positive, 17% were HPV-16 positive, and 11% were HPV-18 positive. Overall, 21 women (12%) developed CIN 2+, with a median time to detection of 25 months. Factors associated with progression to CIN 2+ were presence of HPV-18 (relative risk = 3.04; 95% CI = 1.09–8.44) and HPV-16 and/or HPV-18 at recruitment (relative risk = 3.98; 95% CI = 1.60–9.90). The sensitivity and specificity of a combined HPV-16/HPV-18 test for the detection of CIN 2+ during 3 years were 58% and 78%, respectively.

Conclusions: Our results suggest that women with confirmed CIN 1 have low rates of progression to high-grade CIN within 3 years. Because the median time to progression was 25 months, conservative management could recommend the next repeat cytology at 2 years.

Copyright © 2014 by the American Society for Colposcopy and Cervical Pathology


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