title: A prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2, based on simple clinical parameters.
abstract: This study aims to develop a prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2 (CIN 2) lesions based on simple clinicopathological parameters. The study was conducted at Maastricht University Medical Center, the Netherlands. The prediction model was developed in a retrospective cohort of 129 women with a histologic diagnosis of CIN 2 who were managed by watchful waiting for 6 to 24months. Five potential predictors for spontaneous regression were selected based on the literature and expert opinion and were analyzed in a multivariable logistic regression model, followed by backward stepwise deletion based on the Wald test. The prediction model was internally validated by the bootstrapping method. Discriminative capacity and accuracy were tested by assessing the area under the receiver operating characteristic curve (AUC) and a calibration plot. Disease regression within 24months was seen in 91 (71%) of 129 patients. A prediction model was developed including the following variables: smoking, Papanicolaou test outcome before the CIN 2 diagnosis, concomitant CIN 1 diagnosis in the same biopsy, and more than 1 biopsy containing CIN 2. Not smoking, Papanicolaou class <3, concomitant CIN 1, and no more than 1 biopsy containing CIN 2 were predictive of disease regression. The AUC was 69.2% (95% confidence interval, 58.5%-79.9%), indicating a moderate discriminative ability of the model. The calibration plot indicated good calibration of the predicted probabilities. This prediction model for spontaneous regression of CIN 2 may aid physicians in the personalized management of these lesions.
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands. Electronic address: margot.koeneman@mumc.nl.
authors.forename: Margot M
authors.initials: MM
authors.lastname: Koeneman
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands.
authors.forename: Freyja H M
authors.initials: FHM
authors.lastname: van Lint
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands.
authors.forename: Sander M J
authors.initials: SMJ
authors.lastname: van Kuijk
authors.affiliation: Department of Epidemiology, Maastricht University, 6200 MD, Maastricht, the Netherlands.
authors.forename: Luc J M
authors.initials: LJM
authors.lastname: Smits
authors.affiliation: Department of Pathology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands.
authors.forename: Loes F S
authors.initials: LFS
authors.lastname: Kooreman
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands.
authors.forename: Roy F P M
authors.initials: RFPM
authors.lastname: Kruitwagen
authors.affiliation: Department of Obstetrics and Gynecology, Maastricht University Medical Center, 6202 AZ, Maastricht, the Netherlands; GROW-School for Oncology and Developmental Biology, Maastricht University, 6200 MD, Maastricht, the Netherlands.
authors.forename: Arnold J
authors.initials: AJ
authors.lastname: Kruse
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D019540:Area Under Curve; D001706:Biopsy; D003127:Colposcopy; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D060787:Neoplasm Grading; D009365:Neoplasm Regression, Spontaneous; D009426:Netherlands; D065006:Papanicolaou Test; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000473:pathology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000209:etiology / Q000473:pathology*
keywords: CIN 2; Low-grade squamous intraepithelial lesion; Personalized management; Prediction; Regression