Conservative management of cervical intraepithelial neoplasia grade 2 (CIN2) in women under 30 years of age: A cohort study.

OBJECTIVE: To assess the safety of conservative management of cervical intraepithelial neoplasia grade 2 (CIN2) in women aged under 30 years. STUDY DESIGN: A retrospective cohort study at Queen's Hospital, London, UK. We reviewed patient records and 'Open Exeter' cytology results of 178 women aged less than 30 years with histologically proven CIN2 between 1st April 2014 and 31st March 2016. Analysis included rates of spontaneous regression of CIN2, the persistence of abnormality, the progression to CIN3 and cancer, duration of conservative management, and the number of patients that defaulted follow-up. RESULTS: Of 178 women, 69 women underwent primary treatment of CIN2 with large loop excision of the transformation zone (LLETZ). Nine women defaulted follow-up after their first appointment. One hundred women were managed conservatively with colposcopy, cytology and cervical biopsy. Overall 57% had successful conservative management with regression of high-grade lesion on colposcopy and negative cytology; 32% had failed conservative management and LLETZ, and 11% of women defaulted follow-up with abnormal cytology. Only 13% of women managed conservatively progressed to CIN3, with no woman developing cancer at a median follow-up of 22 months. In women with successful conservative management features of high-grade dysplasia on colposcopy resolved in a significantly shorter time-period compared to normalisation of their cytology (p = 0.021). CONCLUSION: Conservative management of CIN2 appears reasonable and safe in women under the age of 30 years, with 57% showing regression to negative cytology. There is a significant time lag before cytology becomes negative, so early recourse to treatment based on cytology alone is not advised where colposcopy is satisfactory and reassuring.

Dissection of soft-preserved cadavers in the training of gynaecological oncologists: report of the first UK workshop.

OBJECTIVE: To assess the surgical anatomy knowledge of gynaecological oncology (GO) trainees and to evaluate the impact of a cadaveric dissection course on postgraduate surgical training. METHODS: An intensive 3-day cadaveric dissection course with illustrated lectures and supervised dissection, with a multiple-choice questionnaire (MCQ) on surgical anatomy at the beginning and end of the course was organised in the Anatomy Facility of a London Medical School. Each cadaver was embalmed with a mixture of alcohol, phenol and glycerol ("soft-preserved") rather than fixed in formalin, to more closely preserve in vivo conditions of the body. There were ten dissecting delegates, two per cadaver. The delegates dissected the abdomen and pelvis with the emphasis on surgical approaches rather than the classical descriptive anatomy approaches. Delegates also completed a course evaluation. RESULTS: Without negative marking, the mean initial MCQ score was 57%, and final mean score 64%. With negative marking, the mean initial score was 43%, and mean final score 53%. Delegates rated the course highly, would recommend it to other trainees and considered that such a course should be incorporated into subspecialty training. CONCLUSION: The surgical anatomy knowledge of subspecialty trainees was weak but improved as a result of the dissection course. The most positive finding was the course evaluation. Postgraduate surgical training in GO would likely be enhanced by, and arguably requires, cadaveric dissection. "Soft-preserved" rather than formalin-fixed cadavers should be used.