Discrepancies Between Biopsy-based and Excision-based Grading of Cervical Intraepithelial Neoplasia

The Important Role of Time Between Excision and Biopsy

Abstract

We sought to evaluate the rate of cervical intraepithelial neoplasia (CIN)≤1 in loop electrosurgical excision procedure (LEEP) specimens after the treatment of biopsy-proven CIN 2-3, and to identify factors that are associated with the rate of CIN≤1, especially focusing on the time interval between biopsy and LEEP. The goal of this research is to reduce the overtreatment of women with CIN 2-3. This was a retrospective study performed on women undergoing LEEP for biopsy-proven CIN 2-3 in Qilu hospital in Shandong, China. Patients were separated according to LEEP pathology (CIN≤1 vs. CIN 2–3), and compared using the χ² test and Student t test. The main outcome measures were pathologic discrepancy (defined as CIN 2–3 at biopsy, but CIN≤1 at excision). Of the 391 women with biopsy-proven CIN 2-3, 26.9% had LEEP specimens with CIN≤1 histologies. The likelihood of a CIN≤1 LEEP specimen increases for greater biopsy-LEEP intervals (odds ratio, 1.374; 95% confidence interval, 1.089–1.735; P=0.008). Cases in younger women and biopsy-assessed CIN 2 cases were both more likely to have CIN 1 or negative LEEP specimens. The rate of spontaneous histologic regression (defined as CIN≤1 at resection) was 26.9%. These low-grade lesions were more common in LEEP specimens from young women with CIN 2 at biopsy, and who underwent LEEP later after the initial biopsy.