title: Evaluation of conservative management of high-grade cervical squamous intraepithelial lesion.
abstract: OBJECTIVE
  To assess the association between conservative management of high-grade cervical squamous intraepithelial lesions and recurrence rates and age groups.
  
  
  METHODS
  Cross-sectional, retrospective, analytical observational study of 509 women (aged 15 to 76) with abnormal Pap smears attending a public reference center in the city of Maringá, southern Brazil, from 1996 to 2006. Data was collected from medical records, and the variables definitive diagnosis, type of treatment provided, occurrence of high-grade cervical squamous intraepithelial lesions and recurrence were studied. Pearson's chi-square test and Fisher's exact test were used in the statistical analyses.
  
  
  RESULTS
  There were 168 cases of cervical high-grade cervical squamous intraepithelial lesions, of these, 31 were treated with cold-knife conization, 104 loop electrosurgical excision procedure, 9 hysterectomy and 24 conservative treatment (i.e., clinical and cytological follow-up or cervical electrocoagulation). A total of 8 (33.3%) women receiving conservative and 10 (6.9%) receiving non-conservative management had recurrent disease and this difference was statistically significant (p=0.0009), PR = 4.8 (95%CI 2.11;10.93). Three (30.0%) women among those undergoing clinical and cytological follow-up and five 5 (35.7%) among those submitted to cervical electrocoagulation had recurrent disease within three years, but the difference was not significant (p=0.5611). Recurrent rates in those younger and older than 30 were 13.8% (7 women) and 12.2% (11 women) (p = 0.9955).
  
  
  CONCLUSIONS
  Age is not a predictor of disease recurrence. Conservative treatment is only recommended in exceptional situations due to its high recurrence rates. Careful cytological and colposcopic follow-up is required for three years when most recurrences occur.
authors.affiliation: Departamento de Medicina, Centro de Ciências da Saúde, Universidade Estadual de Maringá, Maringá, PR, Brasil. nuchimura@hotmail.com
authors.forename: Nelson Shozo
authors.initials: NS
authors.lastname: Uchimura
authors.forename: Taqueco Teruya
authors.initials: TT
authors.lastname: Uchimura
authors.forename: João Paulo de Oliveira Branco
authors.initials: JP
authors.lastname: Martins
authors.forename: Fernando
authors.initials: F
authors.lastname: Assakawa
authors.forename: Liza Yurie Teruya
authors.initials: LY
authors.lastname: Uchimura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D012189:Retrospective Studies; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000628:therapy*; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000628:therapy*; D055815:Young Adult