Factors predicting the spontaneous regression of cervical high-grade squamous intraepithelial lesions (HSIL/CIN2)
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GYNECOLOGIC ONCOLOGY
Factors predicting the spontaneous regression of cervical high‑grade squamous intraepithelial lesions (HSIL/CIN2) Jean‑Luc Brun1,2 · Déborah Letoffet3 · Marion Marty3 · Romain Griffier4 · Xavier Ah‑Kit1 · Isabelle Garrigue2,5 Received: 21 April 2020 / Accepted: 17 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To determine clinical, pathological and virological factors predicting the spontaneous regression of HSIL/CIN2. Methods This retrospective study included 73 patients with HSIL/CIN2 diagnosed by biopsy between 2012 and 2016 and followed-up without treatment in the department of gynecology at Bordeaux University Hospital. All biopsies sampled inside or outside our department were reviewed and immunolabelled for p16 and Ki67. The response rate was the regression or the disappearance of HSIL/CIN2 as defined by the regression or the disappearance of initial colposcopic findings, cytological and/or histological results. Results The diagnosis of CIN2 was confirmed in 63 of 70 biopsies available for review. The Cohen’s kappa coefficient was κ = 90%, indicating almost perfect inter-observer agreement. The lesion spontaneously regressed or disappeared in 36 of 60 patients (60%) with confirmed CIN2 during a median follow-up of 20 months (range 6–55). Baseline factors influencing the response rate were colposcopic findings (69% with minor change vs 31% with major change, p = 0.033), cytological results (72% with ASCUS/LSIL vs 28% with ASC-H/HSIL, p = 0.018), and HPV genotyping (71% with HPV not 16 vs 42% with HPV-16, p = 0.027). The other factors (age, smoking, surface area of the lesion, p16 and Ki67 expressions) did not significantly influence the outcome. Conclusion Colposcopic findings, cytological results, and HPV genotyping were baseline factors predicting spontaneous regression of HSIL/CIN2. Keywords CIN2 · Follow-up · Colposcopy · Cytology · HPV
Introduction In 2014 the WHO Classification of Tumours of Female Reproductive Organs proposed grouping cervical intraepithelial neoplasia (CIN) 2 and 3 under the high-grade squamous intraepithelial lesions (HSIL) designation [1].
However, it is acknowledged that CIN2 is a mix of biological CIN1 and CIN3, resulting from colposcopic biopsy sampling and pathologic interpretive variability. Therefore, in women who want to preserve their fertility, clinicians may request that pathologists distinguish HSIL (CIN2) from
1
Déborah Letoffet [email protected]
Department of Gynecology, University Hospital of Bordeaux, Place Amélie Raba Leon, 33076 Bordeaux, France
2
Marion Marty marion.marty@chu‑bordeaux.fr
UMR 5234, Microbiology and Pathogenicity, University Hospital of Bordeaux, Bordeaux, France
3
Romain Griffier romain.griffier@chu‑bordeaux.fr
Department of Pathology, University Hospital of Bordeaux, Bordeaux, France
4
Xavier Ah‑Kit [email protected]
Department of Public Health, University Hospital of Bordeaux, Bordeaux, France
5
Laboratory of Virology, Univ
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