Fuchs Karin, Weitzen Sherry, Wu Lily, Phipps Maureen G, Boardman Lori A
Department of Obstetrics and Gynecology, Women and Infants' Hospital of Rhode Island/Brown University Medical School, Providence, Rhode Island 02905, USA.
J Pediatr Adolesc Gynecol. 2007 Oct;20(5):269-74. doi: 10.1016/j.jpag.2007.04.012.
To evaluate regression rates among adolescents (aged < or =21) with cervical intraepithelial neoplasia (CIN) 2 managed expectantly and to determine factors associated with disease regression.
Cohort study using a colposcopic database of 2,996 women seen between August 1999 and November 2005.
Colposcopy clinic in urban, tertiary care medical center.
Adolescents with CIN 2. Routine management consisted of two options: immediate treatment or repeat colposcopic evaluation in 6 months.
For those managed conservatively, regression was defined either as a subsequent normal colposcopy and/or biopsy and at least 2 smears read as negative for epithelial abnormality or at least 3 consecutive negative smears if repeat colposcopy was not performed. Demographic information, including age, was assessed to determine possible associations with disease regression.
Of the 93 adolescents, 53 (57%) elected to undergo immediate treatment with a diagnostic excisional procedure, and 40 (43%) chose management with colposcopic follow-up. Of those treated, high-grade disease (CIN 2+) was found in 40 (75%). Of the 36 young women followed conservatively (4 were lost to follow-up), regression after a median follow-up time of 378 days was documented in 14 (39%). Of the 22 adolescents not fulfilling our criteria for regression, only 3 had evidence of CIN 2 or worse during follow-up. The remaining 19 had either CIN 1 or mildly abnormal cytologic results. Kaplan-Meier survival estimates indicated younger age (< or =16 years) tended to be associated with decreased time to regression.
Based on significant regression of CIN 2 among adolescent women, primary management in this population should consist of cytologic and colposcopic follow-up.
评估对宫颈上皮内瘤变（CIN）2级进行观察等待的青少年（年龄≤21岁）的病变消退率，并确定与疾病消退相关的因素。
队列研究，使用1999年8月至2005年11月间2996名女性的阴道镜检查数据库。
城市三级医疗中心的阴道镜检查诊所。
患有CIN 2级的青少年。常规管理包括两种选择：立即治疗或6个月后重复阴道镜评估。
对于采取保守治疗的患者，病变消退定义为随后阴道镜检查和/或活检正常，且至少2次涂片上皮异常结果为阴性；若未进行重复阴道镜检查，则至少3次连续涂片阴性。评估包括年龄在内的人口统计学信息，以确定与疾病消退的可能关联。
93名青少年中，53名（57%）选择通过诊断性切除手术立即治疗，40名（43%）选择阴道镜随访管理。在接受治疗的患者中，40名（75%）发现为高级别病变（CIN 2+）。在36名接受保守随访的年轻女性中（4名失访），中位随访时间378天后，14名（39%）记录有病变消退。在22名未达到我们的消退标准的青少年中，随访期间只有3名有CIN 2级或更严重病变的证据。其余19名有CIN 1级或轻度细胞学异常结果。Kaplan-Meier生存估计表明，年龄较小（≤16岁）往往与病变消退时间缩短相关。
基于青少年女性CIN 2级病变的显著消退情况，该人群的初始管理应包括细胞学和阴道镜随访。
