Expectant follow-up of Low-grade SIL of the cervix: effectiveness and safety of long-term observation (48 months) in women under 45.

Background: Excisional treatments of precancerous lesions of the cervix are associated with a significantly increased risk of preterm birth and obstetric morbidity. Considering the natural history of CIN, it is advisable, particularly for women under 40-45, to abstain from treatment in case of Low-grade lesion (HPV <plusminus> CIN1). However, strict follow-up is needed for these patients. <P>Methods: We analysed the results of periodical follow-up of LSIL patients, to confirm the effectiveness (prompt detection and treatment of progressed lesions and regression or persistence of the remainder) and safety (no risk of invasive cancer during follow-up intervals). Moreover, the progression potential of "vaccine" HPV types (16-18) and "other" hrHPV types has been compared. Patients eligible for the study were 191: age <less>45 yy, with no recurrent LSIL, hrHPV-DNA positive, satisfactory colposcopy (type 1 or 2 TZ), immunocompetent, without suspicion of endocervical or glandular pathology. The period of follow-up continued up to 48 months and was conducted 6-monthly with cytology and colposcopy (and biopsy when indicated).During follow-up, in case of progression to HSIL or other indications, excisional treatment was performed: loop excision by radiosurgery or cold knife conization. <P>Results: progression, regression, and persistence rates are reported in Table 1<IMAGE01><BR>After 48 months follow-up only 10 patients (5.2%) remained with persistent hrHPV-DNA positive, without significant cervical lesions. No cases of invasive disease were found during follow-up intervals. The prevalence of low-grade (HPV<plusminus>CIN1) were not significantly different in "16-18" and "others" cohorts. Evaluating the Kaplan-Meyer curves of progression/regression/persistence probability during follow-up with Mantel--Haenzsel log rank test, no significant differences in progression potential were found in the two cohorts.<IMAGE02> <P>Conclusions: The long-term expectant follow-up of cervical LSIL (up to 48 months) has showed to be safe and effective. Moreover, vaccine is probably going to revolutionize the policy of cervical cancer prevention, but the importance of rarer (non vaccine) high-risk HPV types must not be underestimated.