Short-term outcome of cervical intraepithelial neoplasia grade 2: considerations for management strategies and reproducibility of diagnosis.
OBJECTIVE
To compare two management strategies for cervical intraepithelial neoplasia (CIN) 2, and evaluate reproducibility of the diagnosis.


METHODS
Ninety (90) women with biopsy-proven CIN2 diagnosed through the Brazilian public health service were randomly allocated into two groups: 45 in prospective follow-up without treatment, and 45 for radical loop electrosurgical excision procedure (LLETZ). As in the real-life situation, pathology-reviewed diagnoses and HPV genotypes were not available.


RESULTS
Excision of the lesion proved to be more effective than prospective follow-up in reaching clearance of CIN2 (hazard ratio=3.66; 95% confidence interval 2.02-6.64). However, 44.1% of the lesions regressed without treatment during the 12-month follow-up.


CONCLUSIONS
CIN2 lesions regress without treatment in one year, although an ablative procedure is more effective. However, excision of CIN2 may lead to additional morbidity and costs, and tailoring the management on an individual basis may result in better outcome. Misclassification of CIN2 is not a negligible problem.
Guedes
Ana Claudia
AC
Medical School, City São Paulo University (UNICID) Brazil, São Paulo, Brazil. guedesac@terra.com.br
Zeferino
Luis Carlos
LC
Syrjänen
Kari Juhani
KJ
Brenna
Sylvia Michelina Fernandes
SM
D000293:Adolescent; D000328:Adult; D000368:Aged; D003127:Colposcopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009365:Neoplasm Regression, Spontaneous; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*