Loop electrosurgical excision procedure versus expectant management to treat high-grade squamous intraepithelial lesion in women up to 25 years

Document Type : Original Article

Authors

1 Federal University of Rio Grande do Norte-UFRN

2 Department of Gynecology of Federal University of Rio Grande do Norte-UFRN

3 Cervical Pathology Department-UFRN

4 Department of Gynecology and Obstetrics of Potiguar University-UnP

Abstract

considerably.
Aim: To determine outcome of regression in a cohort of women younger than 25 years old with cervical intraepithelial neoplasia grade 2 and 3 (CIN2/3) undergoing treatment with Loop Electrosurgical Excision Procedure (LEEP) or observational management.
Methods: Prospective cohort study was carried out between April 2015 and January 2017 with all newly diagnosed biopsy-proven CIN2/3 outpatients. Analysis was performed that compared women who had immediate surgical treatment with women who chose expectant management. The primary outcome was development of high-grade changes (defined as cytological evidence of atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H), HSIL, adenocarcinoma in situ, atypical glandular cells (AGC), or worse) from at least one Pap Smear (PS) collected every 6 months in the minimum follow-up of 1 year. Comparisons were made using Cox proportional hazards regression analysis.
Results: Sixty-four women were diagnosed through cervical biopsy with CIN 2/3 and could choose between conservative or surgical treatment. In the group up to 19 years of age, 6 (37.5%) with CIN2 chose the expectant management and 10 (62.5%) LEEP. While among 20-25-year-old women, 38 (79.2%) chose surgery and 10 (20.8%), being just 4 with CIN3, chose only follow-up for 1 year. The risk of cytological high-grade abnormality over the follow-up period was 62.5% for expectant management and 4.2% for LEEP group (p=0.001).
Conclusion: Women aged up to 25 years with CIN2/3 undergoing treatment with LEEP had a significantly lower risk of cytological high-grade abnormality at 12 months follow-up compared with those who remained only under clinical observation.

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