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Do Colposcopically Directed Biopsy and Endocervical Curettage Serve to Induce Regression of Cervical Intraepithelial Neoplasia?

Diedrich, Justin T. MD; Felix, Juan C. MD; Lonky, Neal M. MD, MPH

Journal of Lower Genital Tract Disease: October 2014 - Volume 18 - Issue 4 - p 322–325
doi: 10.1097/LGT.0000000000000019
Original Articles

Objective We investigated the clinical and demographic characteristics that could influence regression of cervical intraepithelial neoplasia (CIN) from colposcopy to excision, and evaluated the association of the performance of multiple biopsies and endocervical curettage (ECC) with regression of high-grade (CIN2+) by the time of excisional therapy.

Materials and Methods This was an institutional review board–approved retrospective analysis of 555 patients who had abnormal screening and who underwent colposcopy followed by cervical excision procedures for CIN2+ or high-risk status. We assessed demographic variables, referral reason, colposcopic findings, and the latency between colposcopic biopsy and excision to which we correlated the likelihood of regression of disease on the excisional specimen.

Results Mean age was 39 years, and median interval from colposcopy to excision was 48 days. Neither demographics nor colposcopic findings influenced the probability of regression. Patients with shorter intervals between colposcopy biopsy and excision exhibited a higher rate of regression (p = .04). The addition of ECC to colposcopy was associated with regression (p = .002).

Conclusions During routine colposcopic practice using punch biopsy and ECC when indicated, regression was less likely with longer latency from colposcopy to excision. This was possibly owing to emergence and documentation of persistent occult neoplasia. The effect of intentional complete biopsy excision with conventional tools as a potential therapeutic intervention was not evaluated.

Kaiser Permanente, Anaheim, CA

Correspondence to: Neal M. Lonky, MD, MPH, Department of Obstetrics and Gynecology, Kaiser Permanente, Anaheim, CA. E-mail:

The authors have declared they have no conflicts of interest.

This work was supported by the Department of Research and Evaluation, Southern California Permanente Group.

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