scholarly journals Long-Term Clinical Outcome after Treatment for High-Grade Cervical Lesions: A Retrospective Monoinstitutional Cohort Study

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Annarosa Del Mistro ◽  
Mario Matteucci ◽  
Egle Alba Insacco ◽  
GianLibero Onnis ◽  
Filippo Da Re ◽  
...  
Keyword(s):  
Intraepithelial Neoplasia ◽  
First Year ◽  
High Grade ◽  
Cervical Lesions ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Transformation Zone ◽  
Hpv Test ◽  
Type 3

Background. The aim of this retrospective observational study of women treated for cervical intraepithelial neoplasia grade 2 or worse (CIN2+) was to assess the long-term risk of residual/recurrent high-grade CIN.Materials and Methods. We evaluated 760 women treated by loop electrosurgical excision procedure (684) or conization (76) between 2000 and 2009, and followed up to June 30, 2014 (median follow-up 6.7 years, range 4–14). Visits every 6 months for the first year after treatment and yearly for up to the following 10 years included cytology, colposcopy when indicated, and HPV testing (search and typing).Results. CIN2+ or vaginal intraepithelial neoplasia grade 2 or worse (VAIN2+) was detected in 67 cases (8.8%), 39 at first follow-up and 28 after one/more negative visits. The risk of CIN2+ was higher in case of positive margins (odds ratio (OR) 8.04, 95% CI 4.31–15.0), type 3 transformation zone (OR for CIN3 27.7, 95% CI 2.07–36.9), CIN3+ excision (OR 6.02, 95% CI 1.73–20.9), and positive high-risk HPV test at first follow-up (OR for HPV16: 20.6, 95% CI 6.8–62.6; OR for other hrHPV types: 18.3, 95% CI 5.9–57.0).Conclusion. Residual/recurrent high-grade CIN occurred in <9% cases, and the risk was associated with transformation zone type, lesion grade, margins status, and hrHPV test result at 6–12 months of follow-up.

Effects of Implementing the Dual Papanicolaou Test Interpretation of ASC-H and LSIL Following Bethesda 2014

2020 ◽  
Vol 154 (4) ◽  
pp. 553-558
Author(s):  
Abha Goyal ◽  
Ami P Patel ◽  
Thomas L Dilcher ◽  
Susan A Alperstein
Keyword(s):  
Intraepithelial Neoplasia ◽  
Low Grade ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Papanicolaou Test ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Hpv Test ◽  
Intraepithelial Lesion ◽  
The Impact

Abstract Objectives To evaluate the impact of implementing the dual interpretation of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) and low-grade squamous intraepithelial lesion (LSIL) after the Bethesda System 2014 and to compare it with other indeterminate interpretations. Methods Rates of high-risk human papillomavirus (HPV) positivity and histologic follow-up and the proportion of women with high-grade squamous intraepithelial lesion on histologic follow-up were compared for the combined interpretation of ASC-H and LSIL (ASCHL) and the categories of LSIL, cannot exclude high-grade squamous intraepithelial lesion (LSIL-H) and ASC-H. Results The percentage of ASCHL HPV-positive cases (86.0%) was similar to that of LSIL-H but significantly higher in comparison to that of ASC-H. The rates of cervical intraepithelial neoplasia grade 2 or higher (CIN 2+) and CIN 3+ for ASCHL (29.6% and 3.6%, respectively) were similar to those of LSIL-H and ASC-H. When stratified by HPV test results, the proportions of patients with CIN 2+ and CIN 3+ remained statistically similar to those with ASCHL and with LSIL-H and ASC-H. Conclusions Considering the similar risks of CIN 2+ and CIN 3+ for ASCHL and ASC-H, having a separate category of ASCHL for reporting cervical cytology appears to be redundant.

Human Papillomavirus Detection by Hybrid Capture II and Residual or Recurrent High-Grade Squamous Cervical Intraepithelial Neoplasia after Large Loop Excision of the Transformation Zone (LLETZ)

2005 ◽  
Vol 91 (2) ◽  
pp. 188-192 ◽  
Author(s):  
Luís Otávio Sarian ◽  
Sophie Françoise Mauricette Derchain ◽  
Denise da Rocha Pitta ◽  
Liliana Aparecida Angelo Andrade ◽  
Sirlei Siani Moráis ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Dna Detection ◽  
Intraepithelial Neoplasia ◽  
High Grade ◽  
Transformation Zone ◽  
Hybrid Capture ◽  
Hpv Dna ◽  
Large Loop ◽  
Gynecological Examination

Aims and background The purpose of this study was to assess the association between highly-oncogenic types HPV DNA detection by Hybrid Capture II (HCII) and residual or recurrent high-grade cervical intraepithelial neoplasia (CIN 2 or 3) during the follow-up of women submitted to large loop excision of the transformation zone (LLETZ). Study design In this cohort study, 94 women submitted to LLETZ because of CIN 2 or 3 between March 2001 and September 2002 were followed up twice yearly until September 2003. Follow-up visits consisted of an interview regarding clinical, social and demographic characteristics complemented with gynecological examination with specimen collection for Pap test and HCII and colposcopy. Eighty-one patients attended the first visit (mean 4.8 months, range 3-6) and 75 the second visit (mean 10.9 months, range 7-17 months). McNemar's test to assess the variation of HPV DNA detection following LLETZ, odds ratios (OR) to evaluate the correlation between HPV DNA positivity and residual/recurrent CIN during follow-up, and logistic regression to assess the risk of residual/recurrent CIN were used. Results There was a strong and significant reduction in HPV detection after LLETZ ( P <0.001). HPV DNA detection was correlated with residual/recurrent CIN at the first (OR = 103.4; 95% CI 5.5 to 1961.2) and second (OR = 12.7; 95% CI 1.1 to 345.5) follow-up visits. Multivariate analysis showed HPV persistence as a stand-alone risk factor for residual/recurrent CIN (OR = 50.3; 95% CI 3.8 to 663.1). Conclusions High risk HPV DNA detection decreased substantially after CIN treatment with LLETZ, but HPV persistence was strongly correlated with residual/recurrent CIN.

scholarly journals Long-term follow-up of the risk for cervical intraepithelial neoplasia grade 2 or worse in HPV-negative women after conization

2015 ◽  
Vol 137 (12) ◽  
pp. 2927-2933 ◽  
Author(s):  
Camilla F. Gosvig ◽  
Lene D. Huusom ◽  
Klaus K. Andersen ◽  
Anne Katrine Duun-Henriksen ◽  
Kirsten Frederiksen ◽  
...  
Keyword(s):  
Cervical Intraepithelial Neoplasia ◽  
Intraepithelial Neoplasia ◽  
Cervical Intraepithelial Neoplasia Grade ◽  
Long Term Follow Up

High-Grade Cervical Intraepithelial Neoplasia (CIN) in Pregnancy: Clinicotherapeutic Management

1998 ◽  
Vol 84 (5) ◽  
pp. 567-570 ◽  
Author(s):  
Carlo Penna ◽  
Maria Grazia Fallani ◽  
Maria Maggiorelli ◽  
Elisa Zipoli ◽  
Alessandra Cardelli ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Cervical Intraepithelial Neoplasia ◽  
Young Women ◽  
Intraepithelial Neoplasia ◽  
Histologic Examination ◽  
First Year ◽  
High Grade ◽  
In Pregnancy

An increasing incidence of cervical intraepithelial neoplasia (CIN) among young women has been noticed in recent years. For this reason pregnancy might represent a peculiar opportunity to undergo cytocolposcopic examination for those women who do not take part in a screening program for cervical carcinoma. Diagnosis of CIN during pregnancy poses the question of the management of this disease and particularly of whether it is better to treat the lesion or not during pregnancy. To contribute to the solution of this issue we initiated a study on the management of high-grade CIN in pregnancy. Material and methods Five hundred and seventy-one pregnant women underwent cytologic, colposcopic and, when necessary, histologic examination. Those in whom a CIN was discovered in the first four months of gestation underwent laser conization. When the diagnosis of CIN was made after the sixteenth week of gestation, cytocolposcopic monitoring was performed every eighth week during pregnancy and two months after childbirth. Laser conization was performed under colposcopic guidance in the outpatient setting in all cases. All treated patients were submitted to cytologic, colposcopic and, if necessary, histologic examination every third month in the first year after treatment, every sixth month in the second year and yearly from the third year onwards. Results In 14 (2.4%) of the 571 examined women a CIN III was discovered, 6 of which associated with a human papilloma virus (HPV) infection. Of these, 8 patients, whose diagnosis was made within the sixteenth week of pregnancy, underwent laser conization. In one case a minor hemorrhage occurred during treatment. Two patients reported minor bleeding up to ten days after treatment. No major hemorrhages or cervical stenosis were observed. Histologic examination of the cones confirmed the preoperative diagnosis based on cervical biopsies and the lesion was entirely removed by conization in all cases. Seven of the 8 patients who underwent laser conization during pregnancy had a spontaneous delivery at term. The remaining patient, who had had a previous cesarean section, was again delivered by cesarean section. All treated patients were cured after the first-year follow-up visit. In 6 patients CIN was diagnosed after the sixteenth week of pregnancy. These women underwent cytocolposcopic examination every eighth week during pregnancy and two months after delivery, when the cervical changes associated with gestation had disappeared. Four of these patients showed persistence of CIN at postpartum follow-up and therefore underwent laser conization. In two patients spontaneous regression of the lesion was observed. In no case did progression to invasive carcinoma occur. Conclusions Given the increasing incidence of CIN in young women, the beginning of pregnancy may represent a peculiar opportunity for all pregnant women who do not take part in cervical screening programs to undergo a cytocolposcopic examination. In case of a diagnosis of high-grade CIN within the first 16 weeks of pregnancy, a conservative excisional treatment, which does not expose the pregnancy to any risk, should be carried out in order to confirm the intraepithelial localization of the lesion.

Recurrence after Treatment by Loop Electrosurgical Excision Procedure (LEEP) of High-Grade Cervical Intraepithelial Neoplasia

2002 ◽  
Vol 88 (6) ◽  
pp. 478-480 ◽  
Author(s):  
Silvia Cecchini ◽  
Carmen Beatriz Visioli ◽  
Marco Zappa ◽  
Stefano Ciatto
Keyword(s):  
Recurrence Rate ◽  
Screening Program ◽  
Intraepithelial Neoplasia ◽  
First Year ◽  
Time Interval ◽  
High Grade ◽  
Independent Association ◽  
Loop Electrosurgical Excision ◽  
Loop Electrosurgical Excision Procedure

Purpose To evaluate the recurrence rate of high-grade CIN treated by loop electrosurgical excision procedure (LEEP) and the optimal follow-up schedule. Method 622 cases of CIN2/3 consecutively treated by LEEP in the Florence screening program, with 66.5 months average follow-up (range, 6–195 months), were evaluated. Recurrence was defined as histological evidence of high-grade CIN. Results The average recurrence rate was 9.1% (52 cases). Recurrence was significantly associated to increasing age (χ2 = 12.73, df = 3, P < 001), CIN grade (10.5 vs 6.1%, χ2 = 3.37, df = 1, P = 0.067), and time interval, with the risk of developing a recurrence highest in the first year (7.4%, 95% confidence interval, 5.3–9.5%.), and rare beyond the third year. Multivariate analysis confirmed a significant independent association of age (particularly over age 40) and CIN grade to the risk of recurrence. Conclusions LEEP is an effective procedure for the treatment of high-grade CIN. Most recurrences after LEEP occur in the first 3 years, and non-recurrent cases at that date may stop intensive follow-up and return to current cytological screening every 3 years.

scholarly journals Risk of cervical intraepithelial neoplasia grade 3 or higher (CIN3+) among women with HPV-test in 1990–1992, a 30-year follow-up study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Marit Østlyngen Riibe ◽  
Sveinung Wergeland Sørbye ◽  
Gunnar Skov Simonsen ◽  
Arnfinn Sundsfjord ◽  
Josef Ekgren ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
University Hospital ◽  
First Year ◽  
Hpv 16 ◽  
Study Objective ◽  
Negative Test ◽  
Hpv Status ◽  
Hpv Test

Abstract Background/objective Having a 30-year follow-up of a cohort of women tested for HPV is a unique opportunity to further study long-term risk of CIN3+. The study objective was to compare HPV status at baseline with the risk of CIN3+ in the follow-up period of 30 years. Methods All women (n = 642) referred to the HPV outpatient clinic at the University Hospital of North Norway (UNN) in 1990–1992, with an HPV test at baseline, were included in a prospective cohort. HPV-testing was performed by two different HPV-DNA tests, and genotypes 6, 11, 16, 18, 31 and 33 were identified. High-risk (HR) HPV genotypes (16, 18, 31 and 33) were classified as HPV positive, whereas low-risk (LR) genotypes (6 and 11) in addition to absent HPV were classified as HPV negative. A single cohort in which women were classified for their HPV status underwent follow-up prospectively to the last time-point of observation of 30 years. Results During follow-up, 148 (148/642) cases of CIN3+ were detected, of whom 70.3% (104/148) were HPV positive and 29.7% (44/148) were HPV negative at baseline. The proportions of women who developed CIN3+ following a positive and a negative test were 46.6% (104/223) and 10.5% (44/419), respectively. Most cases of CIN3+ were seen shortly after the baseline HPV test, with 112 cases of CIN3+ diagnosed within the first year. In total, 48.6% (72/148) with HPV 16 and 57.6% (19/33) with HPV 33 developed CIN3+. Within the first year, CIN3+ was detected in 37.8% (56/148) with HPV 16, and 51.5% (17/33) with HPV 33. The long-term risk of CIN3+ was significantly lower than the short-term risk, and mainly associated with HPV 16. Overall, eight cases of cervical cancer were detected. Five were HPV positive, harboured HPV 16 at baseline and developed cervical cancer after 3, 4, 5, 11 and 24 years of follow-up. Conclusion and consequences HPV status at baseline is predictive for the subsequent risk of developing CIN3+. Women with a positive HPV test in 1990–1992 had a significantly higher risk of CIN3+ during 30 years of follow-up than those with a negative test. HPV 16 was associated with the greatest long-term risk of cervical cancer. All patients with a positive HPV test at baseline should be followed up until negative. Trial registration ISRCTN, ISRCTN10836802. Registered 14 December 2020 - Retrospectively registered.

scholarly journals Cold Coagulation of high grade premalignant disease of the cervix – standing the test of time: a Retrospective study

2021 ◽  
Author(s):  
KALPANA RAGUPATHY ◽  
Thummini Jayasinghe ◽  
Wendy McMullen
Keyword(s):  
Survival Curve ◽  
Intraepithelial Neoplasia ◽  
Cumulative Probability ◽  
High Grade ◽  
Long Term Follow Up ◽  
Pre Treatment ◽  
The Uk ◽  
Cold Coagulation

Analyse long term (20 years) cytology and histology outcomes following treatment of high grade cervical intraepithelial neoplasia (HGCIN) with Cold Coagulation (CC).     Methods   All women having CC for HGCIN between Jan 1996 and December 1998 (36 months; n=885) were identified; data was collected on age of patients, symptoms, colposcopy findings and biopsy reports. Local and national (cytology and colposcopy) databases and colposcopy records were used to collect long term follow up data. Probability of CIN recurrence was assessed using Kaplan Meir ‘Survival’ curve.     Results  Follow up data (available for 796) was collected in 2018 capturing 20 years of follow-up data. 281 women were treated for CIN2 and 515 women for CIN3. 791/796(>99%) were treated at first visit and 152/796(19%) had symptoms at presentation. 262/796(33%) had evidence of glandular involvement on pre-treatment biopsy. Probability of having consistently normal cytological follow up was 92%, 89%, 86% and 83% at 5, 10, 15 and 20 years respectively. Cumulative probability of having recurrent HGCIN was 0.5% at 5 years, 1% at 10years, 1.9% at 15 years and 3% at 18 years.      Conclusion  CC is a safe and effective treatment for HGCIN which is now shown to have stood the test of time. We advise more widespread adoption in the UK and globally so long as agreed criteria are met.

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