| Management
of Low-grade Cervical Lesions
in Young Women: The Role of HPV and Other Factors
A.Havráncova
J.
Smahelová
T.
Kosová
R.
Tachezy
Department
of Obstetrics and Gynecology, Faculty of Medicine,
Charles University, Prague, Czech Republic
Dept. of Experimental Virology, Institute of Hematology
and Blood Transfusion, Prague, Czech Republic.
Summary
The follow-up is the most frequently recommended procedure
for the management of the low-grade cervical lesions
in young women. It has been shown that CIN I lesions
regress in 57 % of cases, persist in 32 % and progress
to CIN III in 11 %. Invasion is rare – about
1 %. Here we present our preliminary data from the
follow-up of young woman with Low-grade cervical lesions
(LGL). Our main goal is to determine the regression
rate of LGL in young women.
Method
Since 1998 our Center of Oncology-Gynecological Prevention
(COP) has followed up on 277 women (age range 17-30
years, mean age 23,9 years). The women are sent to
COP by practical gynecologist because of suspicious
cytological and/or colposcopical findings. At COP
we examine each woman colposcopically. The smear for
cytological analysis and for the detection of human
papillomaviruses (HPV) as well as the minibiopsy for
histological analysis is taken. For the HPV detection
hybridization assay HC II and polymerase chain reaction
(PCR) is used. At enrollment, we found 96 women positive
for HPV with both methods. We selected 30 of these
patients who had cytology of LSIL, colposcopy of LGL
and histologically confirmed CIN I. These women were
followed up for 12 months. If both cytological and
colposcopical findings on the follow-up were negative,
we stated that lesion regressed.
Results
In the group of 30 HPV positive women we found spontaneous
regression of 30%, 70 % cases had stationary findings.
We did not observe any progression of the disease
in this group of patients. After 12 months, 37 % of
the observed women cleared HPV infection. At the enrollment
of 277 women, we found 14 women with CIN II or CIN
III and who were also positive for high-risk HPV with
both methods. They were treated and followed up for
22 months on average. All women in this group were
cytologically as well as colposcopically negative
on the follow-up, HPV infection persists in 11 of
these women (79 %).
Conclusion
Our preliminary results suggest that the regression
rate of large LGL lesions in young women that are
positive for HR HPV is much lower than shown by other
authors in previous studies. On the contrary the patients
who were treated for CIN II or CIN III lesions remain
both cytologically and colposcopically negative. Based
on our preliminary data we assume that the size and
the location of the lesion and the positivity for
HPV have to be taken into consideration in the management
of LGL in young women.
|
