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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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Algorithm for managing women with BNCs***. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; HR HPV=high-risk human papillomavirus. ***Chronic anovulation, morbid obesity (Zhao et al, 2009).
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fig2: Algorithm for managing women with BNCs***. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; HR HPV=high-risk human papillomavirus. ***Chronic anovulation, morbid obesity (Zhao et al, 2009).

Mentions: We propose a rational and reliable management pathway for patients with BNCs. We suggest that all HR HPV-positive women with BNCs should undergo colposcopy┬▒biopsy. Multidisciplinary team discussion with cytologists and pathologists in a colposcopy correlation meeting should be considered in women with negative colposcopy before formulating an individualised management plan. Women with negative colposcopy should have a repeat smear including endocervical sampling as well as an HR HPV test in 6 months time. In addition, women who are HR HPV negative, over 40 years of age, high risk (in view of chronic anovulation or morbid obesity), or symptomatic, should be referred to an appropriate specialist for a pelvic ultrasound and endometrial biopsy, to exclude an endometrial pathology (Figure 2).


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

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

Algorithm for managing women with BNCs***. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; HR HPV=high-risk human papillomavirus. ***Chronic anovulation, morbid obesity (Zhao et al, 2009).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig2: Algorithm for managing women with BNCs***. Abbreviations: CGIN=cervical glandular intraepithelial neoplasia; CIN=cervical intraepithelial neoplasia; HR HPV=high-risk human papillomavirus. ***Chronic anovulation, morbid obesity (Zhao et al, 2009).
Mentions: We propose a rational and reliable management pathway for patients with BNCs. We suggest that all HR HPV-positive women with BNCs should undergo colposcopy┬▒biopsy. Multidisciplinary team discussion with cytologists and pathologists in a colposcopy correlation meeting should be considered in women with negative colposcopy before formulating an individualised management plan. Women with negative colposcopy should have a repeat smear including endocervical sampling as well as an HR HPV test in 6 months time. In addition, women who are HR HPV negative, over 40 years of age, high risk (in view of chronic anovulation or morbid obesity), or symptomatic, should be referred to an appropriate specialist for a pelvic ultrasound and endometrial biopsy, to exclude an endometrial pathology (Figure 2).

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