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Are Women with Antecedent Low-Grade Cytology and <CIN2 Findings in Colposcopy Being Overmanaged?

Published:August 07, 2022DOI:https://doi.org/10.1016/j.jogc.2022.06.012

      Abstract

      Objective

      To determine the baseline and cumulative risks of cervical intraepithelial lesion grade 3 (CIN3) and invasive cervical cancer in patients with <CIN2 colposcopy findings after a low-grade screening cytology finding (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion [LSIL]).

      Methods

      By linking administrative databases, including cytology, pathology, cancer registries, and physician billing history, a population-based cohort study was performed on participants with <CIN2 initial colposcopy results after a low-grade antecedent cytology finding, between January 2012 and December 2013. Three and 5-year risks of CIN3 and invasive cervical cancer were generated using Kaplan-Meier survival analysis.

      Results

      Among the 36 887 participants included in the study, CIN3 incidence based on referral cytology were as follows at 3 and 5 years, respectively: normal, 0.7% and 0.9%; ASCUS, 4.31% and 5.6%; and LSIL, 5.9% and 7.2%. Three- and 5-year incidence of invasive cancer were 0% and 0.02% for normal cytology, 0.08% and 0.11% for ASCUS, and 0.04% and 0.07% for LSIL, respectively. Stratifying risk by biopsy result at initial colposcopy, 3- and 5-year CIN3 incidences were 2.85% and 3.81% with a negative biopsy, 7.09% and 8.32% with an LSIL biopsy, and 4.11% and 5.2% when no biopsy was done, respectively. Three- and 5-year incidence of invasive cancer was 0% and 0.05% after a negative biopsy, 0% and 0% after LSIL biopsy, and 0.05% and 0.08% when no biopsy was done, respectively.

      Conclusion

      When initial colposcopy is done after a low-grade screening cytology result and <CIN2 is identified, the risk of CIN3 and invasive cancer is low, particularly when biopsies indicate LSIL. Surveillance strategies should balance the likelihood of detecting CIN3 with the potential harms over management with too frequent screening or colposcopic interventions in low-risk patients.

      Résumé

      Objectif

      Déterminer les risques primaires et cumulatifs de CIN3 et de cancer invasif du col de l’utérus chez les patientes dont la colposcopie a révélé une < CIN2 après une cytologie de bas grade (atypie des cellules malpighiennes de signification indéterminée [ASCUS] ou lésion malpighienne intra-épithéliale de bas grade [LSIL]).

      Méthodologie

      Cette étude a été menée en reliant les données administratives, y compris les rapports cytologiques et anatomopathologiques, les registres de cancer et l’historique de facturation des médecins, afin de former une cohorte populationnelle de participantes chez qui on a observé une < CIN2 à la colposcopie initiale après une cytologie de bas grade entre janvier 2012 et décembre 2013. Les risques de CIN3 et de cancer invasif du col à 3 et 5 ans ont été générés au moyen de la méthode de Kaplan-Meier pour évaluer la survie globale.

      Résultats

      Chez les 36 887 participantes à l’étude, l’incidence de CIN3 à 3 et 5 ans selon la cytologie indicatrice était, respectivement : normale, 0,7 % et 0,9 %; ASCUS, 4,31 % et 5,6 %; et LSIL, 5,9 % et 7,2 %. L’incidence de cancer invasif à 3 et 5 ans était respectivement de 0 % et 0,02 % dans les cas de cytologie normale; de 0,08 % et 0,11 % pour l’ASCUS; et de 0,04 % et 0,07 % pour la LSIL. Après la stratification du risque selon le résultat de la biopsie à la colposcopie initiale, l’incidence de CIN3 à 3 et 5 ans était respectivement de 2,85 % et 3,81 % en cas de biopsie négative; de 7,09 % et 8,32 % en cas de résultat de LSIL à la biopsie; et de 4,11 % et 5,2 % lorsqu’aucune biopsie n’a été réalisée. L’incidence de cancer invasif à 3 et 5 ans était respectivement de 0 % et de 0,05 % après une biopsie négative; de 0 % et 0 % après un résultat de LSIL à la biopsie; et de 0,05 % et 0,08 % lorsqu’aucune biopsie n’a été réalisée.

      Conclusion

      Lorsqu’une colposcopie initiale est réalisée à la suite d’une cytologie de bas grade et qu’une < CIN2 est observée, les risques de CIN3 et de cancer invasif sont faibles, en particulier quand la biopsie révèle une LSIL. Dans les stratégies de surveillance, il y a lieu de viser un juste équilibre entre la probabilité de détecter une CIN3 et les risques des interventions colposcopiques et dépistages trop fréquents dans la prise en charge des patientes à faible risque.

      Keywords

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