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Defining the Longitudinal Risk of CIN 3+ for <CIN 2 Colposcopy for Patients Referred With High-Grade Cytology.

Sabrina Piedimonte¹, Kyle Tsang², Nathaniel Jembere²

¹Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada.

Journal of Lower Genital Tract Disease

|October 31, 2023

Summary

Women referred for colposcopy with high-grade cytology but less than cervical intraepithelial neoplasia (CIN) grade 2 histology face an elevated risk of CIN3 and invasive cervical cancer. Close surveillance is recommended due to these risks.

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Area of Science:

Gynecology
Oncology
Public Health

Background:

High-grade cytology necessitates colposcopy for cervical cancer screening.
Histology results less than CIN2 after colposcopy require careful risk assessment.

Purpose of the Study:

To determine the risk of cervical intraepithelial neoplasia grade 3 (CIN3) and invasive cervical cancer.
Stratify risks based on biopsy results in patients with high-grade cytology and

Main Methods:

Linked administrative databases (cytology, pathology, cancer registries).
Kaplan-Meier survival analysis to calculate 3- and 5-year risks.
Included women with high-grade cytology and

Main Results:

5-year CIN3 incidence ranged from 15.1% (negative biopsy) to 20.0% (no biopsy or LSIL biopsy).
5-year invasive cancer incidence was up to 1.68% (no biopsy) and 1.04% (negative biopsy).
HSIL referrals had higher CIN3 rates (21%) compared to AGC (8.28%) or ASC-H (18%).

Conclusions:

Participants with high-grade cytology and
Close surveillance in colposcopy is warranted for these patients.
Risk stratification by biopsy result is crucial for management.