Management of women with low grade cytology

how reassuring is a normal colposcopy examination?

M E Cruickshank, S C Cotton, L Sharp, L Smart, L G Walker, J Little, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

OBJECTIVES: To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up.

DESIGN: Cohort study within a randomised controlled trial.

SETTING: NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.

POPULATION: Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.

METHODS: Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.

MAIN OUTCOME MEASURES: Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy.

RESULTS: The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative.

CONCLUSION: For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.

Original languageEnglish
Pages (from-to)380-386
Number of pages7
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Volume122
Issue number3
Early online date20 Jun 2014
DOIs
Publication statusPublished - Feb 2015

Fingerprint

Colposcopy
Cell Biology
Human papillomavirus 18
Cervical Intraepithelial Neoplasia
Human papillomavirus 16
Primary Health Care
Cohort Studies
Randomized Controlled Trials
Confidence Intervals

Keywords

  • Adult
  • Anxiety
  • Cervical Intraepithelial Neoplasia
  • Cervix Uteri
  • Cohort Studies
  • Colposcopy
  • Female
  • Follow-Up Studies
  • Great Britain
  • Humans
  • Mass Screening
  • Middle Aged
  • Quality Assurance, Health Care
  • Referral and Consultation
  • Uterine Cervical Dysplasia
  • Uterine Cervical Neoplasms
  • Vaginal Smears

Cite this

Cruickshank, M. E., Cotton, S. C., Sharp, L., Smart, L., Walker, L. G., Little, J., & The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group (2015). Management of women with low grade cytology: how reassuring is a normal colposcopy examination? BJOG-An International Journal of Obstetrics and Gynaecology, 122(3), 380-386. https://doi.org/10.1111/1471-0528.12932

Management of women with low grade cytology : how reassuring is a normal colposcopy examination? / Cruickshank, M E; Cotton, S C; Sharp, L; Smart, L; Walker, L G; Little, J; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group.

In: BJOG-An International Journal of Obstetrics and Gynaecology, Vol. 122, No. 3, 02.2015, p. 380-386.

Research output: Contribution to journalArticle

Cruickshank, ME, Cotton, SC, Sharp, L, Smart, L, Walker, LG, Little, J & The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group 2015, 'Management of women with low grade cytology: how reassuring is a normal colposcopy examination?', BJOG-An International Journal of Obstetrics and Gynaecology, vol. 122, no. 3, pp. 380-386. https://doi.org/10.1111/1471-0528.12932
Cruickshank, M E ; Cotton, S C ; Sharp, L ; Smart, L ; Walker, L G ; Little, J ; The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group. / Management of women with low grade cytology : how reassuring is a normal colposcopy examination?. In: BJOG-An International Journal of Obstetrics and Gynaecology. 2015 ; Vol. 122, No. 3. pp. 380-386.
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abstract = "OBJECTIVES: To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up.DESIGN: Cohort study within a randomised controlled trial.SETTING: NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.POPULATION: Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.METHODS: Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.MAIN OUTCOME MEASURES: Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy.RESULTS: The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95{\%} confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative.CONCLUSION: For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.",
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T1 - Management of women with low grade cytology

T2 - how reassuring is a normal colposcopy examination?

AU - Cruickshank, M E

AU - Cotton, S C

AU - Sharp, L

AU - Smart, L

AU - Walker, L G

AU - Little, J

AU - The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

N1 - Funded by Medical Research Council. Grant Number: G9700808 NHS

PY - 2015/2

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N2 - OBJECTIVES: To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up.DESIGN: Cohort study within a randomised controlled trial.SETTING: NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.POPULATION: Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.METHODS: Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.MAIN OUTCOME MEASURES: Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy.RESULTS: The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative.CONCLUSION: For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.

AB - OBJECTIVES: To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up.DESIGN: Cohort study within a randomised controlled trial.SETTING: NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.POPULATION: Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.METHODS: Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.MAIN OUTCOME MEASURES: Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy.RESULTS: The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative.CONCLUSION: For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.

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KW - Female

KW - Follow-Up Studies

KW - Great Britain

KW - Humans

KW - Mass Screening

KW - Middle Aged

KW - Quality Assurance, Health Care

KW - Referral and Consultation

KW - Uterine Cervical Dysplasia

KW - Uterine Cervical Neoplasms

KW - Vaginal Smears

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JO - BJOG-An International Journal of Obstetrics and Gynaecology

JF - BJOG-An International Journal of Obstetrics and Gynaecology

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