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Do We Perform Too Many Procedures for Cervical Dysplasia in Young Women?

Nadim, Batool MbChb, MSC; Beckmann, Michael MBBS FRANZCOG

Journal of Lower Genital Tract Disease: October 2013 - Volume 17 - Issue 4 - p 385–389
doi: 10.1097/LGT.0b013e31827ccea9
Original Articles

Objective This study aimed to determine if there are differences in the histological findings of excisional biopsies between younger women (aged ≤25 years) and older women who undergo large loop excision of the transformation zone or cone biopsy for a biopsy-proven high-grade squamous intraepithelial lesion (HSIL).

Materials and Methods A retrospective cohort analysis of women referred to a tertiary hospital colposcopy clinic with a colposcopically directed biopsy of HSIL (cervical intraepithelial neoplasia 2 [CIN 2] or CIN 3) during the period of 2008 to 2011 was performed.

The histological excisional biopsy specimens for younger women (aged ≤25 years) were compared with those of older women (aged >25 years.) Bivariate analysis comparing demographic characteristics and outcomes across the 2 study groups was initially undertaken to identify potential confounders for inclusion in the multivariate analysis.

Results Of 348 women who had a satisfactory colposcopic assessment and reported no previous treatment for cervical intraepithelial neoplasia, 87 were 25 years or younger, and 261 women were older than 25 years. After excisional biopsy of the cervix, the histological specimen for younger women was more likely to be reported as CIN 1 or no dysplasia (16.3% vs 8.2%). When adjusted for confounders (parity, smoking, previous sexual infection, and referring Pap smear), age less than 25 years remained an independent predictor of having a histological excisional biopsy specimen reported as CIN 1 or no dysplasia (adjusted odds ratio = 2.35; 95% confidence interval = 1.0–5.49).

Conclusions Younger women with biopsy-proven HSIL (CIN 2/3), have a higher likelihood that the histological specimen after an excisional biopsy of the cervix will be reported as CIN 1 or no dysplasia.

Women 25 years or younger with biopsy-proven high-grade lesion are more likely than older women to have CIN 1 or no dysplasia after excisional biopsy of the cervix.

Mater Health Services, Brisbane, Queensland, Australia

Reprint requests to: Michael Beckmann, MBBS, Mater Health Services, Ground Floor Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101. E-mail:;

The authors have declared they have no conflicts of interest.

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology