Stratified management of cervical intraepithelial neoplasia grade 2 in
women over 25 years old based on conization findings:A retrospective
Objective: Partial patients diagnosed with CIN2 on biopsy
include CIN3 +.To compare the histopathological
results before and after conization of CIN2 for exploring stratified
management for CIN2 in women aged ≥25 years. Design: A
observational retrospective study. Setting: China.
Population: 307 women aged 19~40 years
diagnosed as CIN2 on biopsy with cervical squamocolumnar junction
visible. Methods: Compared immediate conization specimen
histopathology with the biopsy histopathology,and explored the risk
factors to predict CIN3 + in cone histopathology.
Main outcome measures: Cone-histopathology-grading rate of
CIN2. Risk factors predicting cone histopathology upgrading.
Constructing an individualized algorithm for CIN2 stratified management
using risk factors. Results: the cone-histopathology-upgrading
rate of CIN2 was 22.5%(including one case of cervical microinvasive
squamous cell carcinoma).In univariable analysis: age, HPV16/18, HSIL
cytology were high-risk factors of cone histopathology upgrading(CIN3
+)(P<0.05). In multivariable analysis:
HPV16/18(OR 2.399,[95%CI 1.326-4.338]) and HSIL cytology(OR
3.295,[95%CI 1.622-6.692]) were independently risk factors.
Conclusion: CIN2 patients aged ≥25 years were with a higher
proportion of CIN3 + and stratified treatment should
be considered.Patients with HPV16/18 infection and HSIL cytology owned
the highest rate of CIN3 + in the rest cervix,surgical
treatment should be taken. For those with HPV16/18 infecton and
ASCUS/LSIL cytology, or other high-risk HPV infection and HSIL cytology
were with a relatively higher proportion of CIN3 +,
treatment should be individualized. However, for patients with HPV16/18
infection and NILM cytology or other high-risk HPV infection and
ASCUS/LSIL cytology, the risk of CIN3 + was relatively
low,conservative treatment should be taken.