Comparison of expectant vs. excisional/ablative management for CIN2 in the era of HPV testing.

Objective: To investigate conservative and excisional/ablative treatment outcomes for cervical intraepithelial neoplasia grade 2 (CIN2) following introduction of virological test of cure. Design: Retrospective study of prospectively collected data. Setting: Teaching hospital colposcopy unit. Population: 331 sequential biopsy-proven CIN2 cases. Methods: CIN2 cases diagnosed 01/07/2014-31/12/2017 were followed-up until colposcopy discharge and then using the national cervical cytology database. Outcomes were defined: Cytological/histological regression was absence of high-grade CIN on biopsy and/or high-grade dysplasia; Virological regression was cytological/histological regression and negative human papillomavirus testing; Persistence was biopsy-proven CIN2 and/or moderate dyskaryosis; Progression was biopsy-proven CIN3+ and/or severe dyskaryosis. Main outcome measures: Regression, persistence, progression rates; median regression/progression times; referral to discharge interval; subsequent CIN. Results: Median follow-up was 22.6 months (range: 1.9-65.1). 175 (52.9%) patients were initially managed conservatively. 77.3%(133/172) regressed, 13.4%(23/172) persisted and 9.3%(16/172) progressed to CIN3+. 97(56.4%) patients achieved virological regression. Median regression and progression times were 6.1 (range 2.4-30.4) months and 7.6 (range 3.8-43.3) months, respectively. 156 (47.1%) patients underwent initial excision/ablation, with a 89.4%(110/123) virological cure rate. Patients managed conservatively vs. planned excision spent a median of 16.4 and 11.7 months respectively, within colposcopy follow-up. 7 (4.0%) and 3 (1.9%) patients developed further CIN in the conservative and treatment groups respectively, during median 17.2 months post-discharge. Conclusions: Conservative management is a reasonable and effective management strategy in appropriately-selected women with CIN2. The above data provide useful information for clinicians and patients deciding management options. Funding: none Keywords: CIN2; conservative; management; expectant; regression; progression; persistence; excision; HPV; virological