Subsequent risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after a colposcopic diagnosis of CIN 1 or less.
OBJECTIVE
The purpose of this study was to determine the risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after colposcopic diagnosis of CIN 1 or less.


METHODS
After colposcopy for an abnormal cytology, women with CIN 1 or less had annual cytology evaluations and high-risk human papillomavirus (HPV) tests (Hybrid Capture II). Colposcopy was repeated if the cytology result was ASC-H, or worse, ASC-US/high-risk HPV test positive, or every 2 years if the cytology was normal/high-risk HPV test positive. Differences in rates of CIN 3 or cancer were compared by log rank Kaplan-Meier survival analysis.


RESULTS
With median follow-up periods of 26.3 months, 47 of 2490 women (1.9%) with CIN 1 or less subsequently had CIN 3 or cancer. Subsequent CIN 3 or cancer was more likely if the high-risk HPV test was initially positive (45/1960 women [2.3%]) compared with negative (2/530 women [0.4%]; P = .0002) and if women were older (age > or = 30 years, 28/1021 women [2.7%]; age 20-29 years, 17/1017 women [1.7%]; age < 20 years, 2/452 women [0.4%]; P = .045). When CIN 3 or cancer was diagnosed, 45 of 46 women (97.8%) had positive high-risk HPV test and 42/46 women (91.3%) had an abnormal cervical cytology. The yield of CIN 3 or cancer per colposcopy for women (4/205 women [2.0%]) who had normal cervical cytology/positive high-risk HPV tests was lower than for women (41/541 women [7.6%]) who had abnormal cervical cytology/positive high-risk HPV tests (chi-square test, 8.3; P < .005), and it did not increase with increasing length of follow-up.


CONCLUSIONS
Annual cytology and high-risk HPV tests with colposcopy for high-risk HPV test positive/abnormal cytology and at least every 2 years for high-risk HPV test positive/normal cytology is advised after a colposcopic diagnosis of CIN 1 or less.
Pretorius
Robert G
RG
Department of Obstetrics and Gynecology, Southern California Permanente Medical Group, Fontana, CA 92335, USA. Robert.G.Pretorius@kp.org
Peterson
Pat
P
Azizi
Faramarz
F
Burchette
Raoul J
RJ
D000328:Adult; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D027383:Papillomaviridae; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D018570:Risk Assessment; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology*; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology*