title: Discrepancies between biopsy-based and excision-based grading of cervical intraepithelial neoplasia: the important role of time between excision and biopsy.
abstract: We sought to evaluate the rate of cervical intraepithelial neoplasia (CIN) ≤ 1 in loop electrosurgical excision procedure (LEEP) specimens after the treatment of biopsy-proven CIN 2-3, and to identify factors that are associated with the rate of CIN ≤ 1, especially focusing on the time interval between biopsy and LEEP. The goal of this research is to reduce the overtreatment of women with CIN 2-3. This was a retrospective study performed on women undergoing LEEP for biopsy-proven CIN 2-3 in Qilu hospital in Shandong, China. Patients were separated according to LEEP pathology (CIN ≤ 1 vs. CIN 2-3), and compared using the χ2 test and Student t test. The main outcome measures were pathologic discrepancy (defined as CIN 2-3 at biopsy, but CIN ≤ 1 at excision). Of the 391 women with biopsy-proven CIN 2-3, 26.9% had LEEP specimens with CIN ≤ 1 histologies. The likelihood of a CIN ≤ 1 LEEP specimen increases for greater biopsy-LEEP intervals (odds ratio, 1.374; 95% confidence interval, 1.089-1.735; P = 0.008). Cases in younger women and biopsy-assessed CIN 2 cases were both more likely to have CIN 1 or negative LEEP specimens. The rate of spontaneous histologic regression (defined as CIN ≤ 1 at resection) was 26.9%. These low-grade lesions were more common in LEEP specimens from young women with CIN 2 at biopsy, and who underwent LEEP later after the initial biopsy.
authors.affiliation: Qilu Hospital, Shandong University, Licheng, Jinan, Shandong, China Yantaishan Hospital, Zhifu, Yantai, Shandong, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Zhang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.forename: Mingyu
authors.initials: M
authors.lastname: Zhao
authors.forename: Lin
authors.initials: L
authors.lastname: Jia
authors.forename: Youzhong
authors.initials: Y
authors.lastname: Zhang
mesh_terms: D000328:Adult; D001706:Biopsy; D003127:Colposcopy; D004598:Electrosurgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000175:diagnosis*