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Cervical squamous intraepithelial neoplasia grade 1: Recurrence, persistence, and progression in untreated women

Yıl 2018, , 65 - 70, 20.03.2018

Hülya Ayık Aydın , Tayfun Toptaş Tayup Şimşek

https://doi.org/10.7197/223.vi.407665

Öz

Objective: Low grade cervical intraepithelial
neoplasia (CIN) is a relatively common disorder. The course of disease
including recurrence, persistence, and
progression in untreated women is not well-known. The aim of the present study was to
determine the natural history of CIN 1 during a follow-up period
of 3 years.



Method: This
retrospective study involved data extracted from the medical files of 545
patients diagnosed with CIN 1 between 2009 and 2015 in the obstetrics and
gynecology department of a tertiary care center. Initial cervical smear results
were compared to those on the follow-up
visits at 1st, 2nd and 3rd years.



Results: Comparison of initial smear results with follow-up
samples yielded significant improvements on
1st, 2nd, and 3rd years (p<0.001 for all).
In patients ≤ 44 years of age, improvement in smear results on the 2nd year was more noteworthy than
those in patients ˃ 44 years (p=0.011).



Conclusions: Results of the present study imply that To conclude, our results demonstrated that low-grade CIN lesions are less likely to
display a progressive course. Therefore,
prolongation of the screening intervals may be logical for the avoidance of unnecessary visits and procedures,
improvement of the quality of life and
cost-effectivity.   

Anahtar Kelimeler

Cervical intraepithelial neoplasia low grade CIN 1 follow-up cervical smear

Kaynakça

  • 1. Carreon JD, Sherman ME, Guillen D, Solomon D, Herrero R, Jeronimo J, Wacholder S, Rodriguez AC, Morales J, Hutchinson M, et al. CIN2 is a much less reproducible and less valid diagnosis than CIN3: results from a histological review of population-based cervical samples. Int J Gynecol Pathol 2007; 26: 441-6.
  • 2. Castle PE, Stoler MH, Solomon D, Schiffman M. The Relationship of Community Biopsy-Diagnosed Cervical Intraepithelial Neoplasia Grade 2 to the Quality Control Pathology-Reviewed Diagnoses: An ALTS Report. Am J Clin Pathol 2007; 127: 805-15.
  • 3. Ostor AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 1993; 12: 186-92.
  • 4. Cox JT, Schiffman M, Solomon D. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol 2003; 188: 1406-12.
  • 5. Elit L, Levine MN, Julian JA, Sellors JW, Lytwyn A, Chong S, Mahony JB, Gu C, Finch T, Zeferino LC. Expectant management versus immediate treatment for low-grade cervical intraepithelial neoplasia: a randomized trial in Canada and Brazil. Cancer 2011; 117: 1438-45.
  • 6. Bansal N, Wright JD, Cohen CJ, Herzog TJ. Natural history of established low grade cervical intraepithelial (CIN 1) lesions. Anticancer Res 2008; 28(3B): 1763-6.
  • 7. Dijkstra MG, Snijders PJ, Arbyn M, Rijkaart DC, Berkhof J, Meijer CJ. Cervical cancer screening: on the way to a shift from cytology to full molecular screening. Ann Oncol 2014 May; 25: 927-35.
  • 8. Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ: 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. ASCCP-Sponsored Consensus Conference. JAMA 2002; 287: 2120-9.
  • 9. Cuvelier CA, Bogers JP, Bourgain C, Delvenne P, Drijkoningen M, Garbar C, Kevers M, Remmelinck M, Thienpont L, Verhest A, Weynand B, Willocx F. Belgian consensus guidelines for follow-up of women with cervical cytological abnormalities. Acta Clin Belg 2009; 64: 136-43.
  • 10. Castle PE, Sideri M, Jeronimo J, Solomon D, Schiffman M. Risk assessment to guide the prevention of cervical cancer. J Low Genit Tract Dis 2008; 12: 1-7.
  • 11. Trimble CL, Piantadosi S, Gravitt P, Ronnett B, Pizer E, Elko A, et al. Spontaneous regression of high-grade cervical dysplasia: Effects of human papillomavirus type and HLA phenotype. Clin Cancer Res 2005; 11: 4717-23.
  • 12. Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: A meta-analysis. Obstet Gynecol 1998; 92: 727–35.
  • 13. Matsumoto K, Oki A, Furuta R, Maeda H, Yasugi T, Takatsuka N, et al. Tobacco smoking and regression of low-grade cervical abnormalities. Cancer Sci 2010; 101: 2065-73.
  • 14. Moscicki AB, Shiboski S, Hills NK, Powell KJ, Jay N, Hanson EN, et al. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet. 2004; 364: 1678-83.
  • 15. Moscicki AB1, Shiboski S, Hills NK, Powell KJ, Jay N, Hanson EN, Miller S, Canjura-Clayton KL, Farhat S, Broering JM, Darragh TM. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet 2004, 6-12; 364 (9446): 1678-83.

Servikal intraepitelyal neoplazi grade 1: Tedavi edilmemiş kadınlarda rekürrens, persistans ve progresyon

Yıl 2018, , 65 - 70, 20.03.2018

Hülya Ayık Aydın , Tayfun Toptaş Tayup Şimşek

https://doi.org/10.7197/223.vi.407665

Öz

Amaç: Düşük dereceli servikal intraepitelyal neoplazi (CIN)
oldukça yaygın bir bozukluktur. Tedavi edilmemiş kadınlarda rekürrens,
persistans ve progresyonu içeren hastalığın seyri iyi bilinmemektedir. Bu
çalışmanın amacı 3 yıllık takip sürecinde CIN1in doğal gidişatını
belirlemektir.

Yöntem: Bu retrospektif çalışma, 2009 ve 2015 yılları
arasında, üçüncü basamak bakım 
merkezimizdeki jinekolojik onkoloji bölümünde CIN1 tanısı almış 545
hastanın tıbbi verilerini içermektedir. İlk servikal smear sonuçları; 1., 2. ve
3. yıl takiplerdeki sonuçlarla karşılaştırıldı.

Bulgular: İlk smear sonuçları takip örneklerle
karşılaştırıldığında 1., 2. ve 3. yıllara kıyasla anlamlı iyileşme göstermiştir
(p<0.001 hepsi için). ≤ 44 yaş hastalarda 2. yıl smear sonuçlarındaki
iyileşme, ˃ 44 yaş hastalardan daha fazla dikkate değer bulundu (p=0.011).







Sonuç: Mevcut çalışma
sonuçlarına göre, düşük dereceli CIN lezyonları daha az ilerleyici gidişat
gösterme eğilimindedirler. Bu
yüzden gereksiz vizitleri ve işlemleri önlemek, yaşam kalitesini ve maliyet
etkinliği iyileştirmek için  tarama
aralıklarını uzatmak mantıklı olabilir. 

Anahtar Kelimeler

Servikal intraepitelyal neoplazi düşük derece CIN 1 takip servikal smear

Kaynakça

  • 1. Carreon JD, Sherman ME, Guillen D, Solomon D, Herrero R, Jeronimo J, Wacholder S, Rodriguez AC, Morales J, Hutchinson M, et al. CIN2 is a much less reproducible and less valid diagnosis than CIN3: results from a histological review of population-based cervical samples. Int J Gynecol Pathol 2007; 26: 441-6.
  • 2. Castle PE, Stoler MH, Solomon D, Schiffman M. The Relationship of Community Biopsy-Diagnosed Cervical Intraepithelial Neoplasia Grade 2 to the Quality Control Pathology-Reviewed Diagnoses: An ALTS Report. Am J Clin Pathol 2007; 127: 805-15.
  • 3. Ostor AG. Natural history of cervical intraepithelial neoplasia: a critical review. Int J Gynecol Pathol 1993; 12: 186-92.
  • 4. Cox JT, Schiffman M, Solomon D. Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy. Am J Obstet Gynecol 2003; 188: 1406-12.
  • 5. Elit L, Levine MN, Julian JA, Sellors JW, Lytwyn A, Chong S, Mahony JB, Gu C, Finch T, Zeferino LC. Expectant management versus immediate treatment for low-grade cervical intraepithelial neoplasia: a randomized trial in Canada and Brazil. Cancer 2011; 117: 1438-45.
  • 6. Bansal N, Wright JD, Cohen CJ, Herzog TJ. Natural history of established low grade cervical intraepithelial (CIN 1) lesions. Anticancer Res 2008; 28(3B): 1763-6.
  • 7. Dijkstra MG, Snijders PJ, Arbyn M, Rijkaart DC, Berkhof J, Meijer CJ. Cervical cancer screening: on the way to a shift from cytology to full molecular screening. Ann Oncol 2014 May; 25: 927-35.
  • 8. Wright TC Jr, Cox JT, Massad LS, Twiggs LB, Wilkinson EJ: 2001 Consensus Guidelines for the management of women with cervical cytological abnormalities. ASCCP-Sponsored Consensus Conference. JAMA 2002; 287: 2120-9.
  • 9. Cuvelier CA, Bogers JP, Bourgain C, Delvenne P, Drijkoningen M, Garbar C, Kevers M, Remmelinck M, Thienpont L, Verhest A, Weynand B, Willocx F. Belgian consensus guidelines for follow-up of women with cervical cytological abnormalities. Acta Clin Belg 2009; 64: 136-43.
  • 10. Castle PE, Sideri M, Jeronimo J, Solomon D, Schiffman M. Risk assessment to guide the prevention of cervical cancer. J Low Genit Tract Dis 2008; 12: 1-7.
  • 11. Trimble CL, Piantadosi S, Gravitt P, Ronnett B, Pizer E, Elko A, et al. Spontaneous regression of high-grade cervical dysplasia: Effects of human papillomavirus type and HLA phenotype. Clin Cancer Res 2005; 11: 4717-23.
  • 12. Melnikow J, Nuovo J, Willan AR, Chan BK, Howell LP. Natural history of cervical squamous intraepithelial lesions: A meta-analysis. Obstet Gynecol 1998; 92: 727–35.
  • 13. Matsumoto K, Oki A, Furuta R, Maeda H, Yasugi T, Takatsuka N, et al. Tobacco smoking and regression of low-grade cervical abnormalities. Cancer Sci 2010; 101: 2065-73.
  • 14. Moscicki AB, Shiboski S, Hills NK, Powell KJ, Jay N, Hanson EN, et al. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet. 2004; 364: 1678-83.
  • 15. Moscicki AB1, Shiboski S, Hills NK, Powell KJ, Jay N, Hanson EN, Miller S, Canjura-Clayton KL, Farhat S, Broering JM, Darragh TM. Regression of low-grade squamous intra-epithelial lesions in young women. Lancet 2004, 6-12; 364 (9446): 1678-83.
Toplam 15 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Sağlık Kurumları Yönetimi
Bölüm Surgical Science Research Makaleler
Yazarlar

Hülya Ayık Aydın

Tayfun Toptaş

Tayup Şimşek

Yayımlanma Tarihi 20 Mart 2018
Kabul Tarihi 5 Mart 2018
Yayımlandığı Sayı Yıl 2018

Kaynak Göster

AMA Ayık Aydın H, Toptaş T, Şimşek T. Cervical squamous intraepithelial neoplasia grade 1: Recurrence, persistence, and progression in untreated women. CMJ. Mart 2018;40(1):65-70. doi:10.7197/223.vi.407665