title: Management of women with low grade cytology: how reassuring is a normal colposcopy examination?
abstract: OBJECTIVE
  To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up.
  
  
  METHODS
  Cohort study within a randomised controlled trial.
  
  
  METHODS
  NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.
  
  
  METHODS
  Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.
  
  
  METHODS
  Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.
  
  
  METHODS
  Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy.
  
  
  RESULTS
  The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative.
  
  
  CONCLUSIONS
  For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.
authors.affiliation: Obstetrics & Gynaecology, University of Aberdeen, Aberdeen, UK.
authors.forename: M E
authors.initials: ME
authors.lastname: Cruickshank
authors.forename: S C
authors.initials: SC
authors.lastname: Cotton
authors.forename: L
authors.initials: L
authors.lastname: Sharp
authors.forename: L
authors.initials: L
authors.lastname: Smart
authors.forename: L G
authors.initials: LG
authors.lastname: Walker
authors.forename: J
authors.initials: J
authors.lastname: Little
mesh_terms: D000328:Adult; D001007:Anxiety; D002584:Cervix Uteri / Q000473:pathology*; D015331:Cohort Studies; D003127:Colposcopy / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008403:Mass Screening; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000458:organization & administration; D006113:United Kingdom; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000523:psychology; D002583:Uterine Cervical Neoplasms / Q000473:pathology*; D014626:Vaginal Smears
keywords: Cervical intraepithelial neoplasia grade 2; colposcopy; human papillomavirus; low grade abnormalities