Table 1.

Defined clinical outcomes among women with conservative management of equivocal high-grade cervical lesionsa

Outcome categoryDefinitionExampleb
1. Progressed to cancerCancer histology from biopsy or treatmentInitial CIN2 diagnosis followed by a cone biopsy or other procedure, which identified a squamous cell carcinoma
2. TreatedCryotherapyInitial CIN2 diagnosis followed by HPV+/HSIL leading to a LEEP or other treatment (with a histology result other than cancer)
LEEP
Cone biopsy
Hysterectomy
3. Return to routine screening (exit colposcopy)2+ sequential negative cytologies and colposcopies 6 months apart followed by a negative cotest 12 months laterInitial CIN2 diagnosis followed by 2 normal Pap smears and colposcopies at 6 and 12 months and a negative cotest at 24 months
4. High-grade lesionCIN2/3/AIS detected at biopsy without subsequent regressionInitial CIN2 followed by persistent CIN2 or CIN3 or AIS, no regression and no treatment
5. Low-grade lesionRemaining women who did not fit into 4 groups above. All had at least 1 abnormal biopsy, HPV or Pap test, and at least 22 months of follow-upInitial CIN2 followed by persistent HPV positivity, LSIL, or CIN1 (without progression, regression, or treatment)
  • a(i) Women were categorized as developing cancer if any future biopsy or treatment histology resulted in a cancer diagnosis. (ii) Women were considered treated if they underwent a loop electrosurgical excision procedure (LEEP), cold knife cone (cone biopsy), cryotherapy, and/or hysterectomy. (iii) A woman was classified as “exited from colposcopy surveillance” and returned to routine 3-year cotesting if she did not have cancer, a high-grade lesion or receive treatment, and met the KPNC criteria of two or more sequential negative cytologies and colposcopies at least 6 months apart, followed by a negative cotest 12 months later. (iv) Untreated women with at least one subsequent biopsy or treatment finding of CIN2, CIN2/3, CIN3, or AIS that did not regress were categorized as having continued “high-grade lesions.” (v) Finally, a woman was categorized as having a “low-grade lesion” if she did not fall into the other 4 categories, but had a CIN1 or low-grade squamous intraepithelial lesion result in either biopsy or cytology or tested HPV-positive.

  • bAn example of screening patterns that would lead to each outcome category. These are illustrative examples, not exhaustive lists.