Conservative management of CIN2: National Audit of British Society for Colposcopy and Cervical Pathology members' opinion

• Published in: Journal of obstetrics and gynaecology Vol. 38; no. 3; p. 388
• Main Authors: Macdonald, Madeleine, Smith, John H F, Tidy, John A, Palmer, Julia E
• Format: Journal Article
• Language: English
• Published: England 03.04.2018
• Subjects: Adult; Attitude of Health Personnel; Cervical Intraepithelial Neoplasia - pathology; Cervical Intraepithelial Neoplasia - therapy; Cervical Intraepithelial Neoplasia - virology; Cervix Uteri - pathology; Colposcopy; Conservative Treatment; Female; Health Care Surveys; Human papillomavirus 16 - isolation & purification; Human papillomavirus 18 - isolation & purification; Humans; Immunocompromised Host; Practice Guidelines as Topic; Smoking; United Kingdom; Uterine Cervical Neoplasms; treatment; spontaneous regression; CIN2; conservative management; high-grade CIN
• ISSN: 1364-6893
• DOI: 10.1080/01443615.2017.1316973

There is no doubt that organised cervical screening programmes have significantly reduced the rates of cervical cancer by detection and treatment of high-grade cervical intraepithelial neoplasia (CIN2, CIN3). National UK guidelines do not differentiate between CIN2 and CIN3 as separate entities and recommend treatment for both, although a degree of uncertainty exists regarding the natural history of CIN2. This national survey of British Society for Colposcopy and Cervical Pathology members aimed to assess attitudes towards conservative management (CM) of CIN2 in the UK and identify potential selection criteria. In total, 511 members responded (response rate 32%); 55.6% offered CM for selective cases; 12.4% for all cases; 16.4% had formal guidelines. Most agreed age group was >40yrs (83%), HPV 16/18 positive (51.4%), smoking (60%), immuno-compromise (74.2%), and large lesion size (80.8%) were relative contraindications for CM. 75.9% favoured six-monthly monitoring, with 80.2% preferring excisional treatment for persistent high-grade disease. Many UK colposcopists manage CIN2 conservatively without formal guidelines. Potential selection criteria should be investigated by a multicentre study. Impact statement Although anecdotally some colposcopists manage many women with CIN2 conservatively, this National Audit of British Society for Colposcopy and Cytopathology members, we believe, is the first time this has been formally recorded. The survey assesses current attitudes towards conservative management (CM) of CIN2 and seeks to identify potential selection criteria that could be used to identify suitable women. It received over 500 responses and significantly, identified many colposcopists recommending CM of CIN2 for patients despite the lack of any formal guidance regarding this approach. The greater majority of respondents were keen to consider participating in a multicentre trial on CM of CIN2 targeting the UK screening population (25-64 years). The paper has international relevance as ACOG and ASCCP have recently changed their guidance for the management of CIN2 in younger women and now recommend CM with monitoring rather than first line ablative or excisional treatment due to concerns regarding overtreatment, especially in women who have not yet completed their family.