Immediate Referral to Colposcopy Versus Cytological Surveillance for Minor Cervical Cytological Abnormalities in the Absence of HPV Test

Summary

A Cochrane review [Abstract] 1 included 5 studies with a total of 11 466 subjects. There were 18 cases of invasive cervical cancer, 7 in the immediate colposcopy and 11 in the cytological surveillance groups, respectively. Although immediate colposcopy detects cervical intra-epithelial lesion, CIN2+ and CIN3+ earlier than cytology, the differences were no longer observed at 24 months (table T1). The inter-study heterogeneity was considerable (I² over 90%). When the exit examination was excluded, the detection rate of high-grade lesions at the 18-month follow-up was higher after immediate colposcopy, both had substantial inter-study heterogeneity (I² over 60%). Immediate referral to colposcopy significantly increased the detection of clinically insignificant cervical abnormalities, as opposed to repeat cytology after 24 months of surveillance, incidence of any CIN (64% versus 32%, RR 2.02, 95% CI 1.33 to 3.083; 2 studies, n=656 women; low quality evidence), and incidence of CIN1. The risk for default was higher for the repeat cytology group, with a 4-fold increase at 6 months, a 6-fold at 12 and a 19-fold at 24 months (table T1).