Treatment strategies in intermediate cervical neoplasia: Implications of radical surgery

Treatment strategies for cervical intraepithelial neoplase (CIN)2 lesions differ among gynaecologists. To evaluate the differences in management of treatment with subsequent implications, all surgical treatment strategies and follow-up methods were retrospectively analysed for patients with intermediate dysplasia of the cervix. This study aimed to evaluate expectant management strategies and the effect of biopsy prior to radical surgery in CIN2. Patients diagnosed with a CIN2 lesion at the Orbis Medical Center in The Netherlands between 2006 and 2007 were retrospectively analysed. The follow-up ended on 1st January 2009. All 141 patients with CIN2 lesions were included; 109 had no previous history of any CIN lesion. Of the 109 patients, 12% (n=13) underwent an immediate radical surgical excision of the transformation zone (LLETZ procedure) and 85% (n=93) underwent a local biopsy. After the lesion was biopsied, expectant management was selected for 59% of the patients. Subsequent smears were normal in 40% of the patients. Of the patients with abnormal smears in follow-up, the LLETZ procedure was performed in 86% of the patients (n=25). Of these cases, persistent disease was observed in 14% of the patients. After an immediate LLETZ procedure without prior biopsy, follow-up smears were abnormal in 31% of the patients. Persistent disease was significantly lower following radical excision of the lesion with a diagnostic biopsy versus without one (14 versus 31%). After expectant management, the rate of persistent disease was 53% (p<0.001). Overall, the rate of persistent disease was 7%. Due to the high rate of persistent disease and the lower rate of overtreatment, CIN2 lesions should be treated by the excisional procedure. To restrict persistent disease, a biopsy is recommended prior to the actual treatment, since a higher rate of abnormal smears was observed in the follow-up after immediate radical excisions in the first visit.