title: The clinical meaning of a cervical intraepithelial neoplasia grade 1 biopsy.
abstract: OBJECTIVE
  To determine whether the diagnosis of cervical intraepithelial neoplasia (CIN) grade 1 increases the risk of CIN 3 above what is observed for human papillomavirus (HPV) infection.
  
  
  METHODS
  Using data from the atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) triage study, we compared the 2-year cumulative risk of CIN 3 for women with an enrollment diagnosis of CIN 1 (n=594) (median age 23 years) compared with those with negative histology or no biopsy taken at colposcopy ("no CIN 1," n=570) (median age 24 years). Baseline cervical specimens were tested for carcinogenic HPV by a clinical HPV test and HPV genotypes by polymerase chain reaction. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) as a measure of association of enrollment status, including CIN 1 compared with no CIN 1 diagnosis, with 2-year worst outcomes of CIN 3.
  
  
  RESULTS
  The two-year risks of CIN 3 were 10.3% (95% CI 7.9-13.0) for women with CIN 1, 7.3% (95% CI 4.6-10.9) for negative histology, and 6.4% (95% CI 3.8-9.9) for women referred to colposcopy and no biopsies were taken (P=.1). The 2-year risks of CIN 3 for women positive for HPV16, HPV18, or other carcinogenic HPV genotypes were 19.1%, 13.9%, and 5.7%, respectively, and did not differ significantly by the baseline cytology interpretation (ASCUS or LSIL). Taking HPV genotypes into account, having a CIN 1 (compared with no CIN 1) was not a risk factor for developing CIN 3 (OR 0.99, 95% CI 0.54-1.8).
  
  
  CONCLUSIONS
  A CIN 1 diagnosis does not represent a significant risk factor for CIN 3 above the risk attributed to its molecular cause, genotype-specific HPV infection.
  
  
  METHODS
  II.
authors: From the American Society for Clinical Pathology Institute, Washington, DC; the Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland; and the Department of Pathology, University of New Mexico Health Sciences Center, School of Medicine, Albuquerque, New Mexico.
authors: Philip E
authors: PE
authors: Castle
authors: Julia C
authors: JC
authors: Gage
authors: Cosette M
authors: CM
authors: Wheeler
authors: Mark
authors: M
authors: Schiffman
mesh_terms: D001706:Biopsy; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D030361:Papillomavirus Infections / Q000150:complications; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology