title: Risk factors for treatment failure following cold coagulation cervical treatment for CIN pathology: a cohort-based study.
abstract: OBJECTIVE
  To determine any risk factors for cytology recurrence in women after cold coagulation ablative treatment for cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  This was a retrospective observational study of a cohort of women having had cold coagulation between 2001 and 2011 in the colposcopy unit of an NHS hospital. We retrospectively collected data from our colposcopy unit database. Women with previous cervical treatment were excluded.
  
  
  RESULTS
  559 eligible women were identified with a mean age of 28.7 ± 6.2 years. Nulliparous women were 66.3 % with smokers involving 35.3 %. Referral cytology, pretreatment cervical punch biopsies and colposcopy were high grade in 51.9, 71.9 and 45.8 % of women. Endocervical crypt involvement (ECI) on pretreatment cervical punch biopsy involved 9.7 % of women. Mean follow-up was 3.1 ± 2.4 years. Overall cytology recurrence (mild/moderate/severe dyskaryosis) at 6 and 12 months follow-up was 7.4 and 5 %. High-grade cytology recurrence (moderate/severe dyskaryosis) involved 2.7 % of women over the entire follow-up period. Multiple regression analysis showed that ECI on pretreatment cervical punch biopsy was a risk factor for high-grade cytology recurrence (HR 3.72; 95 %CI 1.18-11.71; p = 0.024). There were no risk factors identified for overall cytology recurrence. However, when cytology tests with borderline nuclear changes at follow-up were pooled with mild/moderate/severe dyskaryosis cytology tests, then parity ≥2 was a risk factor for abnormal cytology (HR 1.71; 95 %CI 1.08-2.69; p = 0.022).
  
  
  CONCLUSIONS
  Endocervical crypt involvement on pretreatment cervical punch biopsy and multiparity ≥2 are risk factors that increase the likelihood of abnormal cytology following cold coagulation. These two risk factors should be taken in consideration when performing cold coagulation cervical treatment for CIN pathology.
authors.affiliation: Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK. dimitrios.papoutsis@nhs.net.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Papoutsis
authors.affiliation: Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
authors.forename: Martyn
authors.initials: M
authors.lastname: Underwood
authors.affiliation: Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
authors.forename: William
authors.initials: W
authors.lastname: Parry-Smith
authors.affiliation: Department of Obstetrics and Gynaecology, Shrewsbury and Telford Hospitals NHS Trust, Apley Castle, Grainger Drive, Telford, TF16TF, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Panikkar
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003080:Cold Temperature; D003127:Colposcopy; D017679:Cryotherapy / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D011247:Pregnancy; D012017:Referral and Consultation; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*; D002578:Uterine Cervical Dysplasia / Q000473:pathology / Q000601:surgery*
keywords: CIN; Cold coagulation; Cytology recurrence; Endocervical crypt involvement; Parity