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Comparative Risk of High-Grade Histopathology Diagnosis After a CIN 1 Finding in Endocervical Curettage Versus Cervical Biopsy

Gage, Julia C. PhD, MPH1; Duggan, Máire A. MD2; Nation, Jill G. MD3; Gao, Song MSc4; Castle, Philip E. PhD, MPH5

Journal of Lower Genital Tract Disease: April 2013 - Volume 17 - Issue 2 - p 137–141
doi: 10.1097/LGT.0b013e3182630c41
Original Articles

Objective No evidence-based clinical management recommendations exist for women with an endocervical curettage (ECC) cervical intraepithelial neoplasia grade 1 (CIN 1) result when the concurrent cervical biopsy is not high-grade. For women with these pathologic findings, we assessed their short-term risk of high-grade histopathologic diagnosis in the Calgary Health Region where ECC was routinely performed.

Materials and Methods We analyzed pathology and colposcopy reports from 1,902 referral colposcopies where both ECC and biopsies were normal or CIN 1. We calculated the short-term risk of CIN 2 or more severe (CIN 2+) detected 12 to 24 months after colposcopy. Pearson χ2 tests or Fisher exact tests were used to compare risks of a CIN 2+ diagnosis between combinations of test results and strata of risk factors.

Results The short-term risk of CIN 2+ was the same after a CIN 1 biopsy and CIN 1 ECC (4.9% of 1,389 vs 5.0% of 359, respectively, p = .37). Compared with low-grade referral cytology, the risk of CIN 2+ after high-grade cytology was elevated significantly for CIN 1 ECC (13.3% vs 3.3%, p < .01) and nonsignificantly for CIN 1 biopsy (7.1% vs 4.6%, p = .12).

Conclusions After low-grade cytology, the short-term risk of a high-grade histologic diagnosis in women with either CIN 1 ECC or biopsy is equivalent, suggesting similar management. A CIN 1 ECC may warrant different management in the context of high-grade referral cytology.

The risk of cervical precancer after CIN 1 on either biopsy or endocervical curettage was comparable and may warrant different management after a high-grade cytology.

1Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD; Departments of 2Pathology and Laboratory Medicine and 3Obstetrics and Gynecology, University of Calgary,4Alberta Cervical Cancer Screening Program, Alberta Cancer Board, Alberta, Canada; and 5American Society for Clinical Pathology, Washington, DC

Reprint requests to: Julia C. Gage, PhD, MPH, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, Room 7013, MSC 7234, Rockville, MD 20892-7234. E-mail:

Dr Gage was supported by the Intramural Research Program of the National Institutes of Health, National Cancer Institute.

Dr Castle is compensated for serving on a Data and Safety Monitoring Board for HPV Vaccines for Merck. Dr Castle has received HPV tests and testing for research at a reduced or no cost from Qiagen and Merck. The other authors report no conflict of interest.

©2013The American Society for Colposcopy and Cervical Pathology