Abstract
BackgroundAccording to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive CIN2 p16 in women over the age of 25 should be managed with excisional treatment. However, excisional treatment is associated with physical, psychological and obstetric morbidity and can have a negative impact on sexual function. In our study we sought to identify a clear management strategy, addressing the impact of routine use of p16 immunohistochemistry in this population and identify appropriate criteria for patient selection with the aim of reducing over-treatment.MethodWe studied the medical records of 130 patients who had undergone laser therapy for CIN2. Each patient underwent colposcopy, biopsy and HPV test and were tested for p16 protein,. Patients were divided based on HPV infection into: single infections, multiple infections. All patients underwent ZTA laser therapy with follow-up (2-year follow-up).Statistical analysisContingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p < 0.05 were considered statistically significant.ResultsSingle infections had a histological regression of 61.8% (21/34) and a histological persistence rate of 35.3% (12/34), which was greater than the multiple infection rate. The common characteristic that the women with persistence and progression had was the dimension of the lesion and the genotype 16. Ten cases of histological persistence and the only case of progression had one lesion greater than three quarters of the cervix.ConclusionsWith the progress of our understanding of the natural history of infection from human papillomavirus and the increasing use of colposcopy, thanks to the addition of HPV genotyping and the technique of immunohistochemistry, conservative management of these lesions is now possible.
Highlights
According to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive Cervical Intraepithelial Neoplasia 2 (CIN2) p16 in women over the age of 25 should be managed with excisional treatment
Uncertainty regarding the natural history of CIN2 casts doubt on its potential for spontaneous regression, and it is possible that the regressive nature of CIN2 depends, in some way, on the single pathologist who carried out the diagnosis
We studied the medical records of 130 patients who, from April 2015 to April 2017, had undergone laser therapy for CIN2 at the outpatients’ clinic of Colposcopy of the Gynecology Unit of the University Hospital of Catania (University of Catania, Italy) and we selected the women who met the following inclusion criteria:
Summary
According to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive CIN2 p16 in women over the age of 25 should be managed with excisional treatment. Excisional treatment is associated with physical, psychological and obstetric morbidity and can have a negative impact on sexual function. Human papillomavirus (HPV) infection is a sexually transmitted disease whose prevalence of various genotypes shows significant differences worldwide [3]; to date, over 100 types of HPV have been identified, 18 of which are associated with cervical carcinogenesis. Persistent infection with High-Risk Human Papilloma Virus (hr HPV) is necessary for the development, maintenance and progression of CIN (Cervical Intraepithelial Neoplasia) lesions. Uncertainty regarding the natural history of CIN2 casts doubt on its potential for spontaneous regression, and it is possible that the regressive nature of CIN2 depends, in some way, on the single pathologist who carried out the diagnosis
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