Objectives

Observational management of CIN2 is an option for women under the age of 25. The 2012 American Society for Colposcopy and Cervical Cytology (ASCCP) consensus guidelines¹ provide a framework for this, but are based upon limited clinical data and expert opinion. This study assesses the reliability of colposcopy and cervical cytology in observational management of CIN2 with reference to these guidelines.

Methods

Colposcopy, cervical cytology, and histology data from the PRINCess trial (Observational Management of CIN 2 in Young Women)² at baseline, 6 months, and 12 months review were used to assess the ASCCP recommendations.

Results

Data from 468 patients at the 6 month, and 307 at the 12 month reviews were analysed.

At 6 months, 70 of 468 patients had progressive disease. Of these, 358 had unchanged or improved colposcopy; not performing a biopsy in accordance with the ASCCP guidelines would have missed 44 cases of progressive disease. At 12 months, 27 of 307 patients had progressive disease; 145 women had an unchanged or improved colposcopy among whom 7 cases of progressive disease would be missed without biopsy.

High grade cytology performed reliably in predicting high grade histology at 6 and 12 months.

At 12 months, of 24 women with a normal colposcopy and negative cytology, none had high grade histology.

Conclusion

Cervical cytology performs well in observational management for predicting persistence or progression of CIN2. Colposcopy is a useful guide, but histology provides the gold standard in observational management of CIN2 in women under 25.