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Depth of Cervical Intraepithelial Neoplasia Grade 3 in Peruvian Women: Implications for Therapeutic Depth of Necrosis

Taxa, Luis, MD1; Jeronimo, Jose, MD2; Alonzo, Todd, A., PhD3; Gage, Julia, PhD4; Castle, Philip, E., PhD5; Cremer, Miriam, L., MD6; Felix, Juan, C., MD7

Journal of Lower Genital Tract Disease: January 2018 - Volume 22 - Issue 1 - p 27–30
doi: 10.1097/LGT.0000000000000355
Original Research Articles: Cervix and HPV

Objective To determine the involvement of cervical intraepithelial neoplasia grade 3 (CIN3) in a population of women in a lower-resource setting.

Methods One hundred twelve consecutive cone excision specimens with histological diagnosis of CIN3 were retrieved from the National Institute of Neoplastic Diseases in Lima Peru. Two pathologists independently evaluated each specimen microscopically and confirmed 107 cases that could be measured by optical micrometry. Depth and breadth of the lesions were measured microscopically.

Results The mean maximal depth of cervical involvement by CIN3 was 2 ± 0.13 mm; depth was less than 3.5 mm in 89.7% of cases and less than 5 mm in 93.5%. Mean breadth of CIN3 was 7.3 ± 4.4 mm; breadth was less than 15.9 mm in 95% of cases and less than 20.5 mm in 99.7%. The correlation coefficient between breadth and depth of CIN3 was 0.61. No significant correlation was found between age and depth.

Conclusions Depth of CIN3 involvement in a developing country is significantly deeper than that reported in the United States. Treatment selection for women with CIN3 and risk of treatment failure may vary between developing and developed countries because of the difference in the depth of lesions. Countries with underscreened populations need to consider the increased disease severity in devising treatment strategies.

Pathological analyses of CIN3 specimens from a population in a developing country reveal significantly deeper involvement than those reported in high-income settings.

1National Institute of Neoplastic Diseases, Lima, Peru; 2Global Coalition against Cervical Cancer, Arlington, VA; 3Department of Biostatistics, University of Southern California, Los Angeles, CA; 4Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD; 5Albert Einstein College of Medicine, Bronx, NY; 6Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH; and 7Medical College of Wisconsin, Milwaukee, WI

Reprint requests to: Miriam L. Cremer, MD, MPH, Obstetrics, Gynecology & Women’s Health Institute, Cleveland Clinic Lerner College of Medicine, 9500 Euclid Ave, Cleveland, OH 44195. E-mail:

Financial Support: National Institutes of Health grant award number 1UH2CA189883-01 (recipient Miriam L. Cremer). Additional support provided by the Einhorn Family Charitable Trust.

Conflict of Interest Statement: Dr Cremer is a paid consultant for Merck and has received honoraria as a speaker. Dr Castle has received commercial HPV tests for research at a reduced or no cost from Roche, Qiagen, Norchip, Arbor Vita Corporation, BD, and MTM. He has been compensated financially as a member of a Merck Data and Safety Monitoring Board for HPV vaccines. Dr Castle has been a paid consultant for Gen-Probe/Hologic, Roche, Cepheid, ClearPath, Guided Therapeutics, Teva Pharmaceuticals, Genticel, Inovio, and GE Healthcare. Dr Castle has received honoraria as a speaker for Roche and Cepheid. Dr Jeronimo has been a paid consultant for Qiagen.

Institutional Review Board Status: An institutional review board human subjects research exemption was requested and approved by the institutional review boards of the National Institute of Neoplastic Diseases in Peru, the Cleveland Clinic, and the University of Southern California.

Role of the Founding Source: The Einhorn Family Charitable Trust provided financial support for this project and NIH Grant Number 189883–01. Neither of these founding sources had any involvement in research design, execution, analysis nor the preparation of this manuscript.

Copyright © 2018 by the American Society for Colposcopy and Cervical Pathology