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Course of cervical intraepithelial neoplasia diagnosed during pregnancy

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Management of high-grade cervical intraepithelial neoplasia [CIN grade 2 or 3 (CIN2–3)] diagnosed during pregnancy is controversial. Monitoring with colposcopy and cytology every 8–12 weeks is advised by the most current guidelines.

Study design

This study analyzes the course of disease in pregnant women with abnormal cytologies or clinically suspicious cervixes.

Results

In total, 139 pregnant women, at a median age of 31 years (range 19–49), treated at the Colposcopy Unit of the University Medical Center Hamburg-Eppendorf between 2011 and 2017 were identified. During pregnancy, at least one biopsy was performed on 70.5% of patients. In 84.7% of cases, CIN2–3 (CIN2 n = 14 (14.3%), CIN3 n = 69 (70.4%)) was detected, 7.1% (n = 7) of women were diagnosed with CIN1, while no dysplasia was found in 8.2% (n = 8) of cases. No interventions were necessary during pregnancy. Despite explicit invitation, only 72.3% of women with CIN2–3 attended postpartal consultations. While 61.7% showed persistent lesions, 5% were diagnosed with CIN1 and 33.3% with complete remission. During pregnancy, 68.7% of women with prepartal CIN2–3 were tested for HPV infection. Later, 49.1% were followed up postpartally by means of HPV testing and histology. HPV clearance was observed in 36.4% of women with complete histological remission. Postpartum conization was performed on 44.6% of patients with prepartal CIN2–3 diagnosis. CIN2–3 was histologically confirmed in 97.3% cases. Progression from persistent CIN3 to microinvasive carcinoma was observed in a single case.

Conclusions

High-grade CIN lesions, diagnosed during pregnancy, show a high rate of regression postpartum; whereas, progression to carcinoma is rare. Close and continuous monitoring rarely has any therapeutic consequences. Compliance for postpartal follow-up needs to be improved.

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References

  1. Insinga RP, Glass AG, Rush BB (2004) Diagnoses and outcomes in cervical cancer screening: a population-based study. Am J Obstet Gynecol 191(1):105–113 (Epub 2004/08/06)

    Article  PubMed  Google Scholar 

  2. Al-Halal H, Kezouh A, Abenhaim HA (2013) Incidence and obstetrical outcomes of cervical intraepithelial neoplasia and cervical cancer in pregnancy: a population-based study on 8.8 million births. Arch Gynecol Obstet. 287(2):245–250 (Epub 2012/10/12)

    Article  PubMed  Google Scholar 

  3. Gravitt PE, Winer RL (2017) Natural history of HPV infection across the lifespan: role of viral latency. Viruses. 9(10):267 (Epub 2017/09/22)

    Article  PubMed Central  CAS  Google Scholar 

  4. Schiffman M, Wentzensen N, Wacholder S, Kinney W, Gage JC, Castle PE (2011) Human papillomavirus testing in the prevention of cervical cancer. J Natl Cancer Inst 103(5):368–383 (Epub 2011/02/02)

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kjaer SK, Frederiksen K, Munk C, Iftner T (2010) Long-term absolute risk of cervical intraepithelial neoplasia grade 3 or worse following human papillomavirus infection: role of persistence. J Natl Cancer Inst 102(19):1478–1488 (Epub 2010/09/16)

    Article  PubMed  PubMed Central  Google Scholar 

  6. Douvier S, Filipuzzi L, Sagot P (2003) Management of cervical intra-epithelial neoplasm during pregnancy. Gynecologie, Obstetrique and Fertilite. 31(10):851–855 (Epub 2003/12/04. Prise en charge d'une neoplasie intra-epitheliale du col de l'uterus en cours de grossesse)

    Article  CAS  PubMed  Google Scholar 

  7. Morimura Y, Fujimori K, Soeda S, Hashimoto T, Takano Y, Yamada H et al (2002) Cervical cytology during pregnancy-comparison with non-pregnant women and management of pregnant women with abnormal cytology. Fukushima J Med Sci 48(1):27–37 (Epub 2002/10/09)

    Article  PubMed  Google Scholar 

  8. Origoni M, Salvatore S, Perino A, Cucinella G, Candiani M (2014) Cervical intraepithelial neoplasia (CIN) in pregnancy: the state of the art. Eur Rev Med Pharmacol Sci 18(6):851–860 (Epub 2014/04/08)

    CAS  PubMed  Google Scholar 

  9. Fader AN, Alward EK, Niederhauser A, Chirico C, Lesnock JL, Zwiesler DJ et al (2010) Cervical dysplasia in pregnancy: a multi-institutional evaluation. Am J Obstet Gynecol. 203(2):113e1–113e6 (Epub 2010/06/05)

    Article  Google Scholar 

  10. McIntyre-Seltman K, Lesnock JL (2008) Cervical cancer screening in pregnancy. Obstet Gynecol Clin N Am. 35(4):645–658 (Epub 2008/12/09)

    Article  Google Scholar 

  11. Vlahos G, Rodolakis A, Diakomanolis E, Stefanidis K, Haidopoulos D, Abela K et al (2002) Conservative management of cervical intraepithelial neoplasia (CIN(2–3)) in pregnant women. Gynecol Obstet Investig 54(2):78–81 (Epub 2003/02/05)

    Article  CAS  Google Scholar 

  12. Bentley J (2012) Colposcopic management of abnormal cervical cytology and histology. J Obstet Gynaecol Can. 34(12):1188–1202 (Epub 2012/12/13)

    Article  PubMed  Google Scholar 

  13. Hillemanns P, Friese K, Dannecker C, Klug S, Seifert U, Iftner T, Hädicke J, Löning T, Horn L, Schmidt D, Ikenberg H, Steiner M, Freitag U, Siebert U, Sroczynski G, Sauerbrei W, Beckmann MW, Gebhardt M, Friedrich M, Münstedt K, Schneider A, Kaufmann A, Petry KU, Schäfer APA, Pawlita M, Weis J, Mehnert A, Fehr M, Grimm C, Reich O, Arbyn M, Kleijnen J, Wesselmann S, Nothacker M, Follmann M, Langer T, Jentschke M (2019) Prevention of cervical cancer: guideline of the DGGG and the DKG (S3Level, AWMF Register Number 015/027OL, December 2017) - Part 2 on Triage. Treatment and Follow-up. Geburtshilfe Frauenheilkd 79(2):160–176. https://doi.org/10.1055/a-0828-7722

    Article  PubMed  Google Scholar 

  14. Jordan J, Arbyn M, Martin-Hirsch P, Schenck U, Baldauf JJ, Da Silva D et al (2008) European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1. Cytopathology 19(6):342–354 (Epub 2008/12/02)

    Article  CAS  PubMed  Google Scholar 

  15. Jordan J, Martin-Hirsch P, Arbyn M, Schenck U, Baldauf JJ, Da Silva D et al (2009) European guidelines for clinical management of abnormal cervical cytology, part 2. Cytopathology 20(1):5–16 (Epub 2009/01/10)

    Article  CAS  PubMed  Google Scholar 

  16. Kuehn W, Gieseking F (2015) Die aktuellen Empfehlungen der AG-CPC zur Kolposkopie 2015. Gyn Praktische Gynäkologie. 20:25–47

    Google Scholar 

  17. Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M et al (2013) 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstet Gynecol 121(4):829–846 (Epub 2013/05/03)

    Article  PubMed  Google Scholar 

  18. WHO. Comprehensive cervical cancer control, a guide to essential practice. 2014;Second Edition:1–364.

  19. Griesser H, Marquardt K, Jordan B et al (2013) Münchner Nomenklatur III: gynäkologische Zytodiagnostik der Zervix. Frauenarzt 54:1042–1048

    Google Scholar 

  20. Massad LS (2012) New guidelines on cervical cancer screening: more than just the end of annual Pap testing. J Lower Genit Tract Dis 16(3):172–174 (Epub 2012/07/24)

    Article  Google Scholar 

  21. Michael CW, Esfahani FM (1997) Pregnancy-related changes: a retrospective review of 278 cervical smears. Diagn Cytopathol 17(2):99–107 (Epub 1997/08/01)

    Article  CAS  PubMed  Google Scholar 

  22. Economos K, Perez Veridiano N, Delke I, Collado ML, Tancer ML (1993) Abnormal cervical cytology in pregnancy: a 17-year experience. Obstet Gynecol 81(6):915–918 (Epub 1993/06/01)

    CAS  PubMed  Google Scholar 

  23. Ciavattini A, Serri M, Di Giuseppe J, Liverani CA, Fallani MG, Tsiroglou D et al (2018) Reliability of colposcopy during pregnancy. Eur J Obstet Gynecol Reprod Biol 229:76–81 (Epub 2018/08/18)

    Article  PubMed  Google Scholar 

  24. Benedet JL, Selke PA, Nickerson KG (1987) Colposcopic evaluation of abnormal Papanicolaou smears in pregnancy. Am J Obstet Gynecol 157(4 Pt 1):932–937 (Epub 1987/10/01)

    Article  CAS  PubMed  Google Scholar 

  25. Valente PT, Schantz HD, Schultz M (1994) Cytologic atypia associated with microglandular hyperplasia. Diagn Cytopathol 10(4):326–331 (Epub 1994/01/01)

    Article  CAS  PubMed  Google Scholar 

  26. Coppolillo EF, De Vega HM, Brizuela J, Eliseth MC, Barata A, Perazzi BE (2013) High-grade cervical neoplasia during pregnancy: diagnosis, management and postpartum findings. Acta Obstet Gynecol Scand. 92(3):293–297 (Epub 2012/08/14)

    Article  PubMed  Google Scholar 

  27. Baldauf JJ, Dreyfus M, Ritter J, Philippe E (1995) Colposcopy and directed biopsy reliability during pregnancy: a cohort study. Eur J Obstet Gynecol Reprod Biol 62(1):31–36 (Epub 1995/09/01)

    Article  CAS  PubMed  Google Scholar 

  28. Tainio K, Athanasiou A, Tikkinen KAO, Aaltonen R, Cardenas J, Hernandes J et al (2018) Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis. BMJ 360:k499 (Epub 2018/03/01)

    Article  PubMed  PubMed Central  Google Scholar 

  29. Yost NP, Santoso JT, McIntire DD, Iliya FA (1999) Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions. Obstet Gynecol 93(3):359–362 (Epub 1999/03/13)

    CAS  PubMed  Google Scholar 

  30. Paraskevaidis E, Koliopoulos G, Kalantaridou S, Pappa L, Navrozoglou I, Zikopoulos K et al (2002) Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum. Eur J Obstet Gynecol Reprod Biol 104(1):67–69 (Epub 2002/07/20)

    Article  PubMed  Google Scholar 

  31. Jain AG, Higgins RV, Boyle MJ (1997) Management of low-grade squamous intraepithelial lesions during pregnancy. Am J Obstet Gynecol 177(2):298–302 (Epub 1997/08/01)

    Article  CAS  PubMed  Google Scholar 

  32. Ahdoot D, Van Nostrand KM, Nguyen NJ, Tewari DS, Kurasaki T, DiSaia PJ et al (1998) The effect of route of delivery on regression of abnormal cervical cytologic findings in the postpartum period. Am J Obstet Gynecol 178(6):1116–1120 (Epub 1998/07/14)

    Article  CAS  PubMed  Google Scholar 

  33. Serati M, Salvatore S, Uccella S, Laterza RM, Cromi A, Ghezzi F et al (2009) Sexual function after radical hysterectomy for early-stage cervical cancer: is there a difference between laparoscopy and laparotomy? J Sex Med 6(9):2516–2522 (Epub 2009/06/25)

    Article  PubMed  Google Scholar 

  34. Lurain JR, Gallup DG (1979) Management of abnormal Papanicolaou smears in pregnancy. Obstet Gynecol 53(4):484–488 (Epub 1979/04/01)

    CAS  PubMed  Google Scholar 

  35. Mailath-Pokorny M, Schwameis R, Grimm C, Reinthaller A, Polterauer S (2016) Natural history of cervical intraepithelial neoplasia in pregnancy: postpartum histo-pathologic outcome and review of the literature. BMC Pregnancy Childbirth 16:74 (Epub 2016/04/09)

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  36. Palle C, Bangsboll S, Andreasson B (2000) Cervical intraepithelial neoplasia in pregnancy. Acta Obstet Gynecol Scand 79(4):306–310 (Epub 2000/04/04)

    Article  CAS  PubMed  Google Scholar 

  37. Karrberg C, Brannstrom M, Strander B, Ladfors L, Radberg T (2013) Colposcopically directed cervical biopsy during pregnancy; minor surgical and obstetrical complications and high rates of persistence and regression. Acta Obstet Gynecol Scand 92(6):692–699 (Epub 2013/04/18)

    Article  PubMed  Google Scholar 

  38. Coppola A, Sorosky J, Casper R, Anderson B, Buller RE (1997) The clinical course of cervical carcinoma in situ diagnosed during pregnancy. Gynecol Oncol 67(2):162–165 (Epub 1997/12/31)

    Article  CAS  PubMed  Google Scholar 

  39. Siristatidis C, Vitoratos N, Michailidis E, Syciotis C, Panagiotopoulos N, Kassanos D et al (2002) The role of the mode of delivery in the alteration of intrapartum pathological cervical cytologic findings during the postpartum period. Eur J Gynaecol Oncol 23(4):358–360 (Epub 2002/09/07)

    PubMed  Google Scholar 

  40. Zhang X, Gao YL, Yang Y (2015) Treatment and prognosis of cervical cancer associated with pregnancy: analysis of 20 cases from a Chinese tumor institution. J Zhejiang Univ Sci B 16(5):388–394 (Epub 2015/05/21)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Burd EM (2003) Human papillomavirus and cervical cancer. Clin Microbiol Rev 16(1):1–17 (Epub 2003/01/15)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Bosch FX, Bernaola IE (2006) The human papillomavirus vaccine and the incorporation of pediatrics in cervical cancer prevention. An Pediatr (Barc). 65(5):411–413 (Epub 2006/12/23. La vacuna frente al virus del papiloma humano y la incorporacion de la pediatria a la prevencion del cancer de cuello uterino)

    Article  CAS  PubMed  Google Scholar 

  43. Morrison EA, Gammon MD, Goldberg GL, Vermund SH, Burk RD (1996) Pregnancy and cervical infection with human papillomaviruses. Int J Gynaecol Obstet 54(2):125–130 (Epub 1996/08/01)

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany

    Donata Grimm

  2. Department of Gynecology and Gynecologic Oncology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Donata Grimm, Isabelle Lang, Katharina Prieske, Anna Jaeger, Volkmar Müller, Sascha Kuerti, Barbara Schmalfeldt & Linn Woelber

  3. Department of Pathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Eike Burandt

  4. Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Susanne Lezius

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Contributions

DG: project development, study design, retrospective data collection, analysis of data and writing the manuscript (original draft); IL: project development, retrospective data collection, statistical analysis, writing and approving the manuscript, KP: project development, data collection, reviewing and approving the manuscript; AJ: project administration, reviewing and approving the manuscript; VM: project administration, review and approving the manuscript, supervision; SK: study review and approving the manuscript; EB: pathological review, writing and approving the manuscript, supervision; SL: statistical advice and analysis, review and approving the manuscript, methodology; BS: reviewing and approving the manuscript, supervision; LW: study design, organization of the dysplasia consultation unit, data collection, analysis of data, writing the manuscript (original draft).

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Correspondence to Donata Grimm.

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All authors declare that they have no conflict of interest. This study was not funded by anybody.

Ethical approval retrospective studies

This article does not contain studies with human participants performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study (Ethics Committee of the Medical Board Hamburg reference number 190504).

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Grimm, D., Lang, I., Prieske, K. et al. Course of cervical intraepithelial neoplasia diagnosed during pregnancy. Arch Gynecol Obstet 301, 1503–1512 (2020). https://doi.org/10.1007/s00404-020-05518-1

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