Cervical excisional treatment of young women: A population-based study

•Biopsies of < CIN2 with HSIL cytology carried as much risk for CIN3+ on LEEP as did CIN2 with HSIL cytology.•CIN2 and cytology < HSIL preceded more LEEPs than any other combination in every age group studied.•The opportunity to reduce excisional harm will be lost if CIN3 and CIN2 are merged into a single histologic category.

ObjectiveAssessment of cytology and biopsy results preceding cervical excisional treatment and their association with excisional histology, to evaluate compliance with treatment recommendations and the potential effect of revisions in cervical histology terminology and usage.MethodData from a unique statewide population-based screening registry was used to describe the use and histologic outcomes of cervical excisional procedures in the year following an abnormal cervical screening cytology.ResultsFrom 2007 to 2011, LEEP rates decreased 87%, 45%, and 16% for women aged 15-20, 21-24, and 25-29 years, respectively. Reductions were attributable to an overall decline in cervical screening and colposcopy, and a decrease in LEEP following a diagnosis of less than cervical intraepithelial neoplasia grade 2 (< CIN2) or CIN2 histology preceded by any abnormal cytology other than high-grade squamous intraepithelial lesion (< HSIL). LEEP rates did not change significantly (p > 0.7) for women aged 30-39 years. Irrespective of age, CIN2 was the most common histologic antecedent of excisional treatment (42%), with most (80%) preceded by < HSIL cytology.ConclusionCervical excisions are an unavoidable consequence of cervical screening. Adherence to treatment guidelines stipulating conservative follow-up of young women with biopsies ≤ CIN2 could significantly decrease the number of excisional procedures and associated harms. This opportunity will be lost if cervical intraepithelial neoplasia grade 3 (CIN3) and some or all of CIN2 are merged into a single histologic category, as has been recently recommended in the United States.