THE ROLE TREATMENT FORCERVICAL INTRAEPITHELIAL NEOPLASIA...

..PLAYS IN THE DISAPPEARANCE OF HUMAN PAPILLOMAVIRUS

Quantitative measurements of acetowhitening may provide an adjunct to colposcopy to identify Cervical Intraepithelial Neoplasia 2/3

Fuente: The role treatment for cervical intraepithelial neoplasia plays in the disappearance of Human Papillomavirus
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Objective:

To explore the role played by excision of the transformation zone in women diagnosed with cervical intraepithelial neoplasia (CIN) in the disappearance human papillomavirus (HPV).


Methods:

In a retrospective, cohort study, women with CIN who were treated by loop electrosurgical excision of the transformation zone (LEEP) were compared to another group of women with CIN who were managed expectantly. The decision to treat or manage expectantly was made by one of the authors on clinical grounds. All patients were evaluated with cervical cytology, HPV DNA testing, and pathologic examination of excised tissue. Among women treated with LEEP, the median lag time was calculated from diagnosis of CIN to treatment. The median time for conversion from HPV positive to negative status in both groups was compared, as well as the one-and-two year cure rates (defined as converting to HPV negative status) in the treated and untreated groups.


Results:

The treated and untreated groups consisted of 61 (55.7%) nulliparous), and 38 (68% nulliparous) patients, respectively. The patients' median age was 30 years (range 16-77) in then treated group, and 25 years (range 17- 55) in the untreated group, (p= NS). The lag time from the initial diagnosis of CIN to treatment was less than one month. The median follow up time was 7 months ( range 1-121 months) in the treated group, and 13 months (range 1-70 months) in the untreated group. In both groups 3% had normal pathology. In the treated group 12 % had CIN 1, 83 % had CIN 2-3, and 2% had cancer. In the untreated group 82% had CIN 1, and 16% had CIN2-3 (p < 0.0001). The one and two year cure rates in the treated and untreated and untreated groups were 65% (+6%), 90%(+4%) and 23% (+7%SE) and 56% (+11%SE) respectively (p < 0.0001). Median time to conversion to a negative HPV status was 7.7 months for the treated patients compared to 19.4 months in the untreated patients (P < 0.0001).


Conclusion:

Despite of having a higher grade of CIN, women treated by LEEP are more likely convert to HPV negative status at one and two years and do so significantly sooner than those managed expectantly.


Keywords:

Treatment for CIN, rate of disappearance for HPV, HPV testing, cytology, colposcopy