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Angelika Kaufmann [1] and Christina Founta [1; 2] and Emmanouil Papagiannakis [3] and Raj Naik [1] and Ann Fisher [1]
Academic Editor: Svein Rasmussen
1, Northern Gynaecological Oncology Centre, Gateshead NHS Foundation Trust, Queen Elizabeth Hospital, Sheriff Hill, Gateshead NE9 6SX, UK, qegateshead.nhs.uk
2, Musgrove Park Hospital, Taunton & Somerset NHS Foundation Trust, Taunton TA1 5DA, UK, nhs.uk
3, DYSIS Medical Ltd, Edinburgh, UK, dysismedical.com
Received Jun 29, 2017; Accepted Nov 2, 2017
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
In cytology-based cervical screening programs, women with high-grade cytology are directly referred for colposcopic examination [1, 2], to identify and treat precancerous changes of the cervix (cervical intraepithelial neoplasia, CIN) and prevent risk for progression to invasive cancer. High-grade CIN lesions identified colposcopically and/or histologically are conventionally excised. Furthermore, immediate treatment of women with high-grade cytology, even in the absence of high-grade colposcopic findings, is not unusual, as up to 84% of cases have been reported to have CIN2 or CIN3 on histology [3, 4].
However, excision of cervical tissue can result in cervical deficiency and increase the risk of miscarriage, preterm labour, preterm premature rupture of membranes [5, 6], and cervical stenosis. Furthermore, when the excision of dysplastic cells is incomplete, repeated treatment may be needed, increasing the risks. Considering that a large cohort of women undergo colposcopy during their childbearing years and that, in younger women, CIN2 has an up to 50% likelihood of regression [7–9], conservative management of CIN2 lesions is becoming increasingly popular amongst clinicians for selected patients [10].
In addition, sensitivity of colposcopy is known to be as low as 55–65% [11–13], punch biopsy has been reported to often miss the highest grade of disease [14], and there is evidence of considerable inter- and intraobserver disagreement between colposcopic assessments [15]. This results in great variation in management and increases the risk for both underdiagnosis and overtreatment.
Despite the importance of removing precancerous lesions with the potential for malignant transformation being beyond dispute, management decisions need to be balanced against the consequences of excising cervical tissue. To aid the process, individual circumstances such as general...