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Management of borderline change in endocervical cells: a more dependable approach.

Kodiathodi S, Chattopadhyay S, Baldwin A, Franks P - Br. J. Cancer (2014)

Bottom Line: There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs).Of the 9001 new referrals, 167 women had BNCs.Current follow-up of BNCs relies heavily on colposcopic assessment.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, Wansbeck Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.

ABSTRACT

Background: There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs). The objective of this study is to determine the clinical outcome of women with BNCs, to determine the accuracy of colposcopy and propose a more robust management algorithm.

Methods: This is a retrospective review of all BNC referrals between January 2006 and December 2011 at the Northumbria Healthcare Trust. Histological diagnosis was based on high-grade histology (CIN 2 or worse). Any high-grade histology in the first year of follow-up was included in the final diagnosis.

Results: Of the 9001 new referrals, 167 women had BNCs. Thirty-seven (22%) were diagnosed with high-grade histology on initial assessment. Sixty women had satisfactory and negative colposcopy, out of which 7 (12%) were detected with high-grade histology/cytology in the first year of follow-up. Overall, 50 high-grade histology (30%), including two invasive carcinomas were detected.

Conclusions: Current follow-up of BNCs relies heavily on colposcopic assessment. A significant proportion of women with negative colposcopy was found to have high-grade histology in the first year of follow-up. We propose a more robust management algorithm to lower the probability of missed high-grade histology in this subgroup of women.

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Initial management and outcome of subsequent follow-up. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; LAVH=laparoscopy-assisted vaginal hysterectomy; LLETZ=large loop excision of transformation zone; SCC=squamous cell carcinoma.
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fig1: Initial management and outcome of subsequent follow-up. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; LAVH=laparoscopy-assisted vaginal hysterectomy; LLETZ=large loop excision of transformation zone; SCC=squamous cell carcinoma.

Mentions: Colposcopy was satisfactory in 156 women (93%). One woman had a repeat cytology on her initial visit, while 11 (7%) underwent cytology surveillance following a normal colposcopy (there were no obvious lesions to biopsy). One woman did not undergo colposcopy at the initial visit, as her biopsy showed inflammation following a colposcopy and diagnostic biopsy in a clinic abroad. Histology was available in 154 women (92%); 9 (5%) excision biopsies and 145 (87%) diagnostic biopsies. Four women had excisional biopsies due to unsatisfactory colposcopy, two on suspicion of high-grade disease on colposcopy and one due to patient request. In two women, the reason for excisional biopsy was not documented. Thirty-seven women (22%) were diagnosed with high-grade histology on initial assessment; 1 (3%) on excision biopsy and 36 (97%) on diagnostic biopsy (Figure 1).


Management of borderline change in endocervical cells: a more dependable approach.

Kodiathodi S, Chattopadhyay S, Baldwin A, Franks P - Br. J. Cancer (2014)

Initial management and outcome of subsequent follow-up. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; LAVH=laparoscopy-assisted vaginal hysterectomy; LLETZ=large loop excision of transformation zone; SCC=squamous cell carcinoma.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150265&req=5

fig1: Initial management and outcome of subsequent follow-up. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; LAVH=laparoscopy-assisted vaginal hysterectomy; LLETZ=large loop excision of transformation zone; SCC=squamous cell carcinoma.
Mentions: Colposcopy was satisfactory in 156 women (93%). One woman had a repeat cytology on her initial visit, while 11 (7%) underwent cytology surveillance following a normal colposcopy (there were no obvious lesions to biopsy). One woman did not undergo colposcopy at the initial visit, as her biopsy showed inflammation following a colposcopy and diagnostic biopsy in a clinic abroad. Histology was available in 154 women (92%); 9 (5%) excision biopsies and 145 (87%) diagnostic biopsies. Four women had excisional biopsies due to unsatisfactory colposcopy, two on suspicion of high-grade disease on colposcopy and one due to patient request. In two women, the reason for excisional biopsy was not documented. Thirty-seven women (22%) were diagnosed with high-grade histology on initial assessment; 1 (3%) on excision biopsy and 36 (97%) on diagnostic biopsy (Figure 1).

Bottom Line: There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs).Of the 9001 new referrals, 167 women had BNCs.Current follow-up of BNCs relies heavily on colposcopic assessment.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynaecology, Wansbeck Hospital, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.

ABSTRACT

Background: There are limited data and guidance from the UK on borderline nuclear change in endocervical cells (BNCs). The objective of this study is to determine the clinical outcome of women with BNCs, to determine the accuracy of colposcopy and propose a more robust management algorithm.

Methods: This is a retrospective review of all BNC referrals between January 2006 and December 2011 at the Northumbria Healthcare Trust. Histological diagnosis was based on high-grade histology (CIN 2 or worse). Any high-grade histology in the first year of follow-up was included in the final diagnosis.

Results: Of the 9001 new referrals, 167 women had BNCs. Thirty-seven (22%) were diagnosed with high-grade histology on initial assessment. Sixty women had satisfactory and negative colposcopy, out of which 7 (12%) were detected with high-grade histology/cytology in the first year of follow-up. Overall, 50 high-grade histology (30%), including two invasive carcinomas were detected.

Conclusions: Current follow-up of BNCs relies heavily on colposcopic assessment. A significant proportion of women with negative colposcopy was found to have high-grade histology in the first year of follow-up. We propose a more robust management algorithm to lower the probability of missed high-grade histology in this subgroup of women.

Show MeSH
Related in: MedlinePlus