AIM:To determine the frequency of cervical cytologic abnormalities in patients who were diagnosed as having CIN 1 and had undergone either cryotherapy or expectant management.

METHODS:A retrospective medical record review of 87 patients with colposcopic cervical biopsy-proven CIN 1, was undertaken including age, parity, menstruation status, cervical cytology reports, colposcopic findings, and cervical cytologic follow-up reports. There were 38 patients (43.7%) treated with cryotherapy and the remainder underwent expectant management.

RESULTS:Mean (SD) age of patients treated with cryotherapy was less than that of the patients who had expectant management (36.2 (9.4) vs 41.1 (9.4) years, respectively, p= 0.02). There were no differences in the frequencies of cervical cytologic abnormalities between the groups at 6- and 12-month-follow-up visits (cryotherapy group vs expectant group: 18.4% vs 18.4% at 6-months and 19.2% vs 16.1% at 12 months).

CONCLUSION:Cryotherapy and expectant management with cytologic surveillance had comparable frequencies of cytologic abnormalities during a 12-month follow-up period. Expectant management requires adherence to follow up and high quality cytology and colposcopy testing. Therefore, it should be reserved for these settings. Cryotherapy may be more reasonable in women who are likely to be lost to follow up and high quality cytology cannot be guaranteed.

BACKGROUND:The optimal management strategy for women with low-grade biopsy-proven cervical intraepithelial neoplasia (CIN) is not clear. Our objective was to compare the effectiveness of regular colposcopic follow-up and treatment of progressive disease only versus immediate treatment.

METHODS:Data were accrued between November 2000 and March 2006 for a noninferiority randomized clinical trial of 415 women with biopsy-proven grade 1 CIN from 8 Canadian and 2 Brazilian colposcopy clinics. Subjects were randomly assigned to either undergo immediate treatment with a loop electrical excision procedure (LEEP) or receive regular colposcopic follow-up for 18 months. The primary outcome was progression of disease to CIN 2 to 3 was based on histology obtained during 18 months of follow-up. Treatments were compared using differences of proportion with a 9% noninferiority margin. Analysis was conducted on the basis of intention-to-treat.

RESULTS:An initial LEEP was performed on 179 women. Disease progression was found in 32. Easily controlled vaginal bleeding occurred in 16 (8.9%). During follow-up, disease progression was identified in 3 (1.7%) women in the immediate treatment arm and 9 (4.4%) in the colposcopic follow-up arm-a tolerable difference of 2.7% with 1-sided 95% confidence interval (CI) upper limit of 6.0%. Compliance with all 3 follow-up visits was 61% overall, but significantly worse in women≤30 years of age (P<.05).

CONCLUSIONS:The risk of progression to CIN grade 2 or 3 or cancer over 18 months was similar in the 2 treatment groups. In Canada and Brazil, follow-up for 18 months is a reasonable management strategy for women with persistent low-grade cytology who are found to have grade 1 CIN on referral for colposcopy and cervical biopsy.