Expectant management or conization for persistent low-grade cervical intraepithelial neoplasia: Analysis of 5-year outcomes

Objective: To investigate to describe outcomes of conization or expectant management for women with persistent (>24 months) low-grade cervical intra-epithelial neoplasia. Methods: This is a retrospective analysis focusing on five-year outcomes after persistent, histologically confirmed, low-grade cervical intra-epithelial neoplasia undergoing conization or expectant management. Results: Charts of 219 women with persistent low-grade cervical lesions were retrieved. Overall, 98 (44.7%) and 121 (55.3%) women had conization and observation, respectively. Patients receiving conization were older than patients having observation (43 (range, 24-77) vs. 39 (range, 25-68) years; p=0.013). Focusing on the group of patients receiving conization, 16 (16.3%) women were diagnosed with CIN2+. The five-year risk of secondary conization was 5% (n=5). Focusing on patients having observation (n=121), 18 (14.8%) patients received conization, after a median of 16.5 (range, 6-30) months. Seven (5.8%) and 11 (9.1%) patients were diagnosed with persistent CIN1 and CIN2+, respectively. Not fully visible squamous-columnar junction at colposcopic examination (p=0.035) was associated with CIN2+ occurrence. No invasive cancer was observed Conclusions: Conization for persistent low-grade cervical intra-epithelial neoplasia revealed “occult” CIN2+ in 16% of patients. However, expectant management appears safe and effective in this context, in women with fully visible squamous columnar junction. The decision between conization and expectant management should be discussed on an individual basis.