Can We Reduce Overtreatment of Cervical High-Grade Squamous Intraepithelial Lesions?

Objective The aim was to evaluate the cytology, colposcopic, and pathological factors associated with the absence of high-grade squamous intraepithelial lesion (HSIL)/cervical intraepithelial neoplasia (CIN) 2–3 lesion on loop electrosurgical excision procedure (LEEP) specimens in women with high-grade cytology and/or HSIL/CIN 2–3 biopsy and the risk of disease persistence/recurrence. Materials and Methods Two-center retrospective study of women undergoing LEEP for high-grade cervical disease between January 2014 and December 2019. Clinical, cytology, colposcopy, and pathology results were evaluated to identify independent predictive factors associated with CIN 1/negative LEEP results. Univariate and multivariate logistic regression models were performed. Follow-up data was evaluated to assess the risk of HSIL/CIN 2–3 persistence/recurrence. Results Six hundred thirty-nine of 801 women (79.8%) had high-grade cytology and 631 (78.8%) HSIL/CIN 2–3 biopsy. High-risk human papillomavirus test was positive in 98% of women. Loop electrosurgical excision procedure specimen showing CIN 1 or less was found in 27%–31%. Normal/low-grade colposcopy (odds ratio [OR] = 2.17, CI = 1.39–3.39, p = .001) and CIN 1/negative biopsy (OR = 3.25, CI = 2.12–4.99, p < .001) were predictors of negative/CIN 1 LEEP result in women with high-grade cytology. Normal/low-grade cytology (OR = 1.77, CI = 1.19–2.64, p = .005), normal/low-grade colposcopy (OR = 1.66, CI = 1.11–2.49, p = .013), and CIN 2 biopsy (OR = 2.75, CI = 1.73–4.39, p < .001) were predictors in women with HSIL/CIN 2–3 biopsy. Women with a negative/CIN 1 LEEP had lower recurrence/persistence than those with confirmed HSIL/CIN 2–3(1 vs 31, p = .002). Positive endocervical margin (OR = 2.85, CI = 1.10–7.36, p = .03) and high-risk human papillomavirus persistence (OR = 41.3, CI = 16–106.7, p < .01) were predictors of HSIL/CIN 2–3 persistence/recurrence. Conclusions A CIN 1/negative LEEP specimen in women with high-grade cytology and/or HSIL/CIN 2–3 biopsy is associated with negative/low-grade cytology, normal/low-grade colposcopic findings and CIN 2 biopsy result before treatment. The HSIL/CIN 2–3 disease persistence/recurrence is low when LEEP specimen does not confirm HSIL/CIN 2–3.