What is it about?
This study found that the grade of referral smear was found to reflect the incidence of underlying higher-grade disease on LLETZ among women with CIN2 punch biopsy. Although it is not unreasonable to perform LLETZ for women with CIN2 and a high-grade smear, much consideration should be given before LLETZ is performed on younger women (<30 years) with a low-grade smear whose histology is incidentally CIN2, owing to the long-term effects of this treatment on pregnancy including the risk of preterm labor.
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Why is it important?
This paper aims to look at the incidence of underlying CIN 3 in patients with CIN 2 punch biopsies and evaluate the results to help clear some of the controversies in the management of CIN 2 biopsies. The question we need to ask as clinicians is whether we need to treat all women with CIN 2. The rationale for treating CIN 2 is that there is a potential of missing an underlying higher grade disease. However, should we treat women under 30 and over 30 differently and does it matter what the referral smear was when the biopsy is CIN 2? This paper looks to answer some of these questions
Perspectives
Writing this paper was a great pleasure, everyone who will read this paper will wonder why was HPV screening not included, which we all agree on its major role in defining the pathway of treating women with cervical intraepithelial neoplasia, but unfortunately during the study period, P 16 staining was only done for a small proportion of the patients and thus was not possible to include it. We hope that everyone finds the information yielded by this research helpful and help guide clinical decisions.
Dr Emmanuel Hakem
University Hospital Galway
Read the Original
This page is a summary of: Association between grade of referral smear and high-grade disease among women with biopsy samples showing cervical intraepithelial neoplasia grade 2, International Journal of Gynecology & Obstetrics, November 2017, Wiley,
DOI: 10.1002/ijgo.12357.
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