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DOI: 10.1055/s-0042-119993
Does CIN2 Have the Same Aggressive Potential As CIN3? A Secondary Analysis of High-Grade Cytology Recurrence in Women Treated with Cold-Coagulation Cervical Treatment
Haben CIN-II dasselbe aggressive Potenzial wie CIN-III? Eine Sekundäranalyse von zytologisch nachgewiesenen hochgradigen Rezidiven nach Kaltkoagulation der ZervixPublication History
received 16 June 2016
revised 08 October 2016
accepted 27 October 2016
Publication Date:
06 April 2017 (online)
![](https://www.thieme-connect.de/media/gebfra/201703/lookinside/thumbnails/10-1055-s-0042-119993_gf1112-1.jpg)
Abstract
Introduction To determine whether women with CIN2 versus CIN3 on pretreatment cervical punch biopsy have less high-grade cytology recurrence following cold-coagulation cervical treatment.
Materials and Methods This was a retrospective study of women having had cold coagulation between 2001–2011 in our colposcopy unit. Women with previous cervical treatment were excluded.
Results We identified 402 women with 260 (64.7 %) cases of CIN2 and 142 (35.3 %) cases of CIN3 on pretreatment cervical punch biopsy. In the total sample, the mean age of women was 27.5 years (SD = 4.9), 75.1 % were nulliparous and 36.6 % were smokers. Referral cytology and pretreatment colposcopic appearance were high-grade in 62.7 % and 57.1 %. The mean follow-up period was 2.8 years (SD = 2.1). Women with CIN2 on pretreatment cervical biopsy when compared to those with CIN3 had less frequently high-grade referral cytology and high-grade pretreatment colposcopic appearances, and had less pretreatment cervical biopsies taken. During the follow-up period, women with CIN2 on pretreatment cervical biopsy had less high-grade cytology recurrence when compared to those women with CIN3 (1.9 vs. 5.6 %, p = 0.046). Multiple stepwise Cox regression analysis showed that women with CIN3 on pretreatment cervical biopsy had 3.21 times greater hazard for high-grade cytology recurrence (HR = 3.21, 95 % CI: 1.05–9.89; p = 0.041) in comparison with CIN2 cases.
Conclusion We found that women with CIN2 on pretreatment cervical punch biopsy had less high-grade cytology recurrence following cold-coagulation treatment in comparison to those with CIN3. This finding lends support to the theory that CIN2 even though a high-grade abnormality might not have the same aggressive potential as CIN3.
Zusammenfassung
Einleitung Ziel der Studie war es, die Häufigkeit von hochgradigen Rezidiven bei Frauen mit CIN-II-Läsionen zu ermitteln, verglichen mit Frauen mit CIN III. Der CIN-II- bzw. CIN-III-Befund basierte auf Stanzbiopsien. Nach der Befundung bestand die Behandlung bei allen Frauen aus einer Kaltkoagulation.
Material und Methoden Es handelt sich um eine retrospektive Untersuchung von Frauen, die zwischen 2001 und 2011 in unserer Kolposkopie-Abteilung behandelt wurden. Frauen, die sich bereits zuvor einer anderen Zervixbehandlung unterzogen hatten, wurden von der Studie ausgeschlossen.
Ergebnisse Insgesamt wurden 402 Frauen untersucht; davon hatten laut Stanzbiopsie 260 Frauen (64,7 %) CIN-II- und 142 Frauen (35,3 %) CIN-III-Läsionen. Das Durchschnittsalter aller in der Studie eingeschlossenen Frauen war 27,5 Jahre (SD = 4,9); davon waren 75,1 % Nullipara und 36,6 % waren Raucherinnen. Basierend auf dem zytologischem Befund und dem kolposkopischen Erscheinungsbild vor der Behandlung hatten 62,7 bzw. 57,1 % der untersuchten Frauen hochgradige Läsionen. Die mittlere Nachbeobachtungszeit betrug 2,8 Jahre (SD = 2,1). Frauen, bei denen vor der Behandlung eine CIN II durch Stanzbiopsie ermittelt wurde, hatten seltener einen hochgradigen zytologischen Befund bzw. ein hochgradiges Erscheinungsbild verglichen mit Frauen mit CIN III, und die Anzahl der vor der Behandlung entnommenen Zervixbiopsien war geringer. Im Nachbeobachtungszeitraum gab es weniger hochgradige Rezidive bei Frauen mit CIN II verglichen mit Frauen, bei denen zuvor eine CIN III zytologisch nachgewiesen wurde (1,9 vs. 5,6 %, p = 0,046). Nach der schrittweisen multiplen Regression nach Cox war das Risiko bei Frauen, bei denen vor der Behandlung eine CIN III mit Stanzbiopsie nachgewiesen wurde, nach der Behandlung ein hochgradiges Rezidiv zu entwickeln, 3,21-mal höher (HR = 3,21, 95 %-KI: 1,05–9,89; p = 0,041) als bei Frauen mit CIN II.
Schlussfolgerung Unsere Ergebnisse zeigen, dass Frauen, bei denen vor der Behandlung eine CIN II durch Stanzbiopsie ermittelt wurde, weniger zytologisch nachweisbare hochgradige Rezidive nach der Behandlung mit Kaltkoagulation entwickelten als Frauen mit CIN III. Dieses Ergebnis stützt die Hypothese, dass, auch wenn die CIN II als hochgradige Anomalie eingestuft wird, CIN II nicht dasselbe aggressive Potenzial wie CIN III hat.
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