Objective: Regarding cytological findings of squamous dysplasia, a comparison was made between a three-tiered classification – low-grade squamous intraepithelial lesion (LSIL), high-grade SIL/cervical intraepithelial neoplasia 2 (HSIL/CIN2), and HSIL/CIN3 – and a two-tiered classification – LSIL and HSIL. The respective risk for CIN2+ and CIN3+ was calculated to make decisions regarding management. Methods: A total of 2,949 women with first-time cytologic findings of squamous dysplasia (LSIL, HSIL/CIN2, or HSIL/CIN3) between January 2013 and June 2016 were enrolled. Subsequent cytological findings and histological diagnoses were evaluated until August 2018. For each category of findings, the risk for CIN2+ and CIN3+ was determined by Kaplan-Meier estimates. The differences in risk between the cytological categories were checked for significance using the log-rank test. Results: For the categories LSIL, HSIL/CIN2, and HSIL/CIN3, the risk for CIN2+ after 12, 24, and 60 months was 3.4, 9.4, and 23.3%; 35.2, 44.8, and 59.8%; and 95.5, 97.8, and 98.9%, respectively. For CIN3+ the risk was 2.0, 5.5, and 13.5%; 28.6, 35.6, and 48.3%; 91.3, 95.6, and 97.9%, respectively. The differences in risk between the categories are highly significant, respectively (p < 0.001). Conclusion: A three-tiered classification of squamous dysplasia such as the Munich Nomenclature III for cytology is suitable for risk-adapted clinical management, especially to avoid overdiagnosis and overtreatment.

1.
Griesser
H
,
Marquardt
K
,
Jordan
B
,
Kühn
W
,
Neis
K
,
Neumann
HH
, et al
Münchner Nomenklatur III
.
Frauenarzt
.
2013
;
54
:
2
7
.
2.
Nayar
R
,
Wilbur
DC
.
The Bethesda System for Reporting Cervical Cytology
. 3rd ed.
New York
:
Springer
;
2015
.
3.
Massad
LS
,
Einstein
MH
,
Huh
WK
,
Katki
HA
,
Kinney
WK
,
Schiffman
M
, et al
Lawson HW for the 2012 ASSCP Consensus Guidelines Conference: 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors
.
J Low Genit Tract Dis
.
2013
;
17
(
5
Suppl 1
):
1
27
. 1089-2591
4.
Bundestag: Krebsfrüherkennungs- und -registergesetz. Bundesgesetzblatt
2013
Teil I Nr. 16, 617-23
5.
R Core Team
. (
2017
). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.URL https://www.R-project.org/
6.
Kurman
RJ
,
Solomon
D
.
The Bethesda System for reporting cervical/vaginal cytological diagnoses
.
New York
:
Springer
;
1994
.
7.
Soost
HJ
,
Baur
S
.
Gynäkologische Zytodiagnostik
. 5th ed.
Stuttgart
:
Thieme
;
1990
.
8.
Kurman
RJ
,
Malkasian
GD
 Jr
,
Sedlis
A
,
Solomon
D
.
From Papanicolaou to Bethesda: the rationale for a new cervical cytologic classification
.
Obstet Gynecol
.
1991
May
;
77
(
5
):
779
82
.
[PubMed]
0029-7844
9.
Syrjänen
K
,
Kataja
V
,
Yliskoski
M
,
Chang
F
,
Syrjänen
S
,
Saarikoski
S
.
Natural history of cervical human papillomavirus lesions does not substantiate the biologic relevance of the Bethesda System
.
Obstet Gynecol
.
1992
May
;
79
(
5 ( Pt 1)
):
675
82
.
[PubMed]
0029-7844
10.
Syrjänen
KJ
.
Management of abnormal PAP smears (MAPS): implications of terminology used in cytopathology
.
[Invited Editorial]
.
J Low Genit Tract Dis
.
2000
Oct
;
4
(
4
):
217
23
.
[PubMed]
1089-2591
11.
Syrjänen
K
,
Shabalova
I
,
Sarian
L
,
Naud
P
,
Longatto-Filho
A
,
Derchain
S
, et al;
NIS Study Research Group
;
LAMS Study Research Group
.
Covariates of high-risk human papillomavirus (HPV) infections are distinct for incident CIN1, CIN2 and CIN3 as disclosed by competing-risks regression models
.
Eur J Gynaecol Oncol
.
2012
;
33
(
1
):
5
14
.
[PubMed]
0392-2936
12.
Crum
CP
.
Symposium part 1: Should the Bethesda System terminology be used in diagnostic surgical pathology?: Point
.
Int J Gynecol Pathol
.
2003
Jan
;
22
(
1
):
5
12
.
[PubMed]
0277-1691
13.
Schneider
V
.
Symposium part 2: Should the Bethesda System terminology be used in diagnostic surgical pathology?: Counterpoint
.
Int J Gynecol Pathol
.
2003
Jan
;
22
(
1
):
13
7
.
[PubMed]
0277-1691
14.
Howell
LP
,
Zhou
H
,
Wu
W
,
Davis
R
.
Significance of subclassifying high-grade squamous intraepithelial lesions into moderate dysplasia/CIN II versus severe dysplasia/CIN III/CIS in the Bethesda System terminology
.
Diagn Cytopathol
.
2004
May
;
30
(
5
):
362
6
.
[PubMed]
8755-1039
15.
Ravinsky
E
,
Baker
P
.
Intermediate-grade squamous intraepithelial lesion may be a valid diagnostic/interpretive category
.
Diagn Cytopathol
.
2009
Feb
;
37
(
2
):
81
5
.
[PubMed]
8755-1039
16.
Stoler
M
,
Bergeron
C
,
Colgan
TC
,
Ferenczy
AS
,
Herrington
CS
,
Kim
KR
, et al
 Squamous cell tumours and precursors. In:
Kurman
RJ
,
Carcangiu
ML
,
Herrington
CS
,
Young
RH
, editors
.
WHO Classification of Tumours of female reproductive Organs
. 4th ed.
Lyon
:
WHO Press
;
2014
. pp.
172
6
.
17.
Darragh
TM
,
Colgan
TJ
,
Cox
JT
,
Heller
DS
,
Henry
MR
,
Luff
RD
, et al;
Members of LAST Project Work Groups
.
The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology
.
Arch Pathol Lab Med
.
2012
Oct
;
136
(
10
):
1266
97
.
[PubMed]
0003-9985
18.
Deutsche Gesellschaft für Gynäkologie und Geburtshilfe
. S3-Leitlinie Prävention des Zervixkarzinoms. 2017 http://www.awmf.org/leitlinien/detail/ll/015-027OL.html (last call 11.10.
2018
)
19.
Kühn
W
.
Kolposkopie zur Früherkennung des Zervixkarzinoms
.
Pathologe
.
2011
Nov
;
32
(
6
):
497
504
.
[PubMed]
0172-8113
20.
Martin-Hirsch
PP
,
Paraskevaidis
E
,
Bryant
A
,
Dickinson
HO
,
Keep
SL
.
Surgery for cervical intraepithelial neoplasia
.
Cochrane Database Syst Rev
.
2013
Dec
;(
12
):
CD001318
.
[PubMed]
1469-493X
21.
Guedes
AC
,
Zeferino
LC
,
Syrjänen
KJ
,
Brenna
SM
.
Short-term outcome of cervical intraepithelial neoplasia grade 2: considerations for management strategies and reproducibility of diagnosis
.
Anticancer Res
.
2010
Jun
;
30
(
6
):
2319
23
.
[PubMed]
1791-7530
22.
Moscicki
AB
,
Ma
Y
,
Wibbelsman
C
,
Darragh
TM
,
Powers
A
,
Farhat
S
, et al
Rate of and risks for regression of CIN 2 in adolescents and young women
.
Obstet Gynecol
.
2010
;
116
:
1373
80
.
[PubMed]
0029-7844
23.
Discacciati
MG
,
de Souza
CA
,
d’Otavianno
MG
,
Ângelo-Andrade
LA
,
Westin
MC
,
Rabelo-Santos
SH
, et al
Outcome of expectant management of cervical intraepithelial neoplasia grade 2 in women followed for 12 months
.
Eur J Obstet Gynecol Reprod Biol
.
2011
Apr
;
155
(
2
):
204
8
.
[PubMed]
0301-2115
24.
McAllum
BE
,
Sykes
PH
,
Sadler
L
Macnab H, Simcock BJ, Mekhail AK: Is the management of CIN 2 always necessary in women under 25 years old? Am J Obstet Gynecol
2011
;205:478e1-7
25.
Macdonald
M
,
Smith
JH
,
Tidy
JA
,
Palmer
JE
.
Conservative management of CIN2: National Audit of British Society for Colposcopy and Cervical Pathology members’ opinion
.
J Obstet Gynaecol
.
2018
Apr
;
38
(
3
):
388
94
.
[PubMed]
0144-3615
26.
Griesser
H
,
Marquardt
K
,
Jordan
B
,
Küppers
V
,
Gieseking
F
,
Kühn
W
.
Das Prozedere bei auffälligen Befunden. Kommentar zur Münchner Nomenklatur III
.
Frauenarzt
.
2015
;
56
:
10
3
.
27.
Kühn
W
,
Gieseking
F
: Die aktuellen Empfehlungen der AG CPC zur Kolposkopie. gyn
2015
;20:25-47
28.
Castle
PE
,
Schiffman
M
,
Wheeler
CM
,
Solomon
D
.
Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2
.
Obstet Gynecol
.
2009
Jan
;
113
(
1
):
18
25
.
[PubMed]
0029-7844
29.
Katki
HA
,
Schiffman
M
,
Castle
PE
,
Fetterman
B
,
Poitras
NE
,
Lorey
T
, et al
Five-year risks of CIN2+ and CIN3+ for women with HPV-positive and HPV-negative LSIL Pap results
.
J Low Genit Tract Dis
.
2013
;
17
(
501
):
43
9
. 1089-2591
30.
Koeneman
MM
,
van Lint
FH
,
van Kuijk
SM
,
Smits
LJ
,
Kooreman
LF
,
Kruitwagen
RF
, et al
A prediction model for spontaneous regression of cervical intraepithelial neoplasia grade 2, based on simple clinical parameters
.
Hum Pathol
.
2017
Jan
;
59
:
62
9
.
[PubMed]
0046-8177
31.
Tainio
K
,
Athanasiou
A
,
Tikkinen
KA
,
Aaltonen
R
,
Cárdenas
J
,
Hernándes
, et al
Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis
.
BMJ
.
2018
Feb
;
360
:
k499
.
[PubMed]
0959-8138
32.
Silver
MI
,
Gage
JC
,
Schiffman
M
,
Fetterman
B
,
Poitras
NE
,
Lorey
T
, et al
Clinical Outcomes after Conservative Management of Cervical Intraepithelial Neoplasia Grade 2 (CIN2) in Women Ages 21-39 Years
.
Cancer Prev Res (Phila)
.
2018
Mar
;
11
(
3
):
165
70
.
[PubMed]
1940-6207
33.
Marquardt
K
,
Ziemke
P
.
Münchner Nomenklatur III: Klassifikation nach Risiko : Verlaufsbeobachtung bei auffälligen plattenepithelialen Befunden
.
Pathologe
.
2018
Feb
;
39
(
1
):
57
64
.
[PubMed]
0172-8113
34.
Demarco
M
,
Lorey
TS
,
Fetterman
B
,
Cheung
LC
,
Guido
RS
,
Wentzensen
N
, et al
Risks of CIN 2+, CIN 3+, and Cancer by Cytology and Human Papillomavirus Status: The Foundation of Risk-Based Cervical Screening Guidelines
.
J Low Genit Tract Dis
.
2017
Oct
;
21
(
4
):
261
7
.
[PubMed]
1089-2591
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.