Outcome of cervical intraepithelial neoplasia 2 diagnosed by punch biopsy in 131 women

Aim:  To study the outcome of biopsy-diagnosed cervical intraepithelial neoplasia (CIN) 2 in patients treated by loop electrosurgical excision procedure (LEEP) or cold knife cone biopsy (CKC). Material and Methods:  Patients (n = 131) were analyzed for histological results on LEEP/CKC specimen. Demographic and risk factors, referral cytology, high risk human papilloma virus (HR HPV) test and follow-up colposcopic clinic visits were studied. Results:  Excisional specimens from LEEP/CKC demonstrated no CIN in 20 (15%), CIN 1 in 17 (13%), CIN 2 in 57 (44%) and CIN 3 in 37 (28%). No invasive cancers were identified. The referral Pap smear was high grade or possible high grade in 52 (40%), low grade in 59 (45%) and inconclusive in 20 (15%). Fourteen patients (11%) had positive excisional margins, eight of the 14 were tested for HR HPV infection before LEEP, and all were positive. Post-treatment HPV testing was performed at the 12-month visit in 6 of the 14 patients who had positive excision margins, and all 6 tested were negative. Two women (1.5%) with clear margins had recurrence of CIN 2, both tested positive for HR HPV after treatment. Conclusion:  Our data showed that a significant number of women (28%) with biopsy-diagnosed CIN 2 had CIN 1 or no dysplasia on subsequent excisional biopsy. The recurrence risk of high grade dysplasia in CIN 2 is low (1.5%). However, due to the high number of patients (72%) with high grade dysplasia at treatment biopsy, caution needs to be exercised when a conservative approach is adopted in the management of CIN 2.