ORIGINAL ARTICLE   

Minerva Obstetrics and Gynecology 2022 December;74(6):489-95

DOI: 10.23736/S2724-606X.21.04844-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

CIN2 in childbearing-age women: may colposcopy help choosing the proper management?

Giovanna BITONTI ¹, Nicolò CLEMENTE ², Anna DEL FABRO ², Paolo MANNA ¹, Monica BUTTIGNOL ², Manuela CADEL ², Costantino DI CARLO ¹, Giorgio GIORDA ², Fulvio ZULLO ^{1, 3}, Francesco SOPRACORDEVOLE ² ✉

¹ Department of Clinical and Experimental Medicine, Obstetrics and Gynecology Unit, Magna Graecia University, Catanzaro, Italy; ² Gynecological Oncology Unit, Centro di Riferimento Oncologico - National Cancer Institute, IRCCS, Aviano, Pordenone, Italy; ³ Department of Neurosciences, Reproductive Sciences, and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy

BACKGROUND: CIN2 is considered a biologically equivocal lesion falling between low- and high-grade cervical dysplasia, but it is often managed with cervical conization as a high-grade lesion. However, since cervical conization can lead to an increased risk of adverse obstetric events, it might be interesting to identify, by colposcopy, a subgroup of women with a low risk of “occult” CIN3 who could be managed with a “wait and see” approach.
METHODS: All the women with CIN2 cervical biopsy from 1999 to 2019 were retrospectively identified. Their colposcopic patterns at the time of biopsy and the histopathological findings on the final cone specimen were compared.
RESULTS: Among the 354 women with CIN2 biopsy included, the overall CIN3+ lesion rate on final cone specimen was 21.4%. The rate of CIN3 on final specimen was higher in women with G2 colposcopy compared to G1 (27.2% vs. 15.9%, P=0.01). Among women with G1 colposcopy, the rate of CIN3+ lesions was significantly higher in women with fine punctation (P=0.02) while no differences in women with thin acetowhite epithelium or fine mosaic emerged.
CONCLUSIONS: In women with CIN2 biopsy, when a G2 pattern or G1 with fine punctation on colposcopy is detected, there is an increased risk of CIN3+ on final histology, therefore an excisional treatment should be preferred. Otherwise, in women with CIN2 biopsy and other G1 patterns on colposcopy, a “wait-and-see” approach could be considered.

KEY WORDS: Colposcopy; Squamous intraepithelial lesions; Watchful waiting; Fine-needle biopsy