COLPOSCOPIC REGRESSION PATTERNS IN HIGH-GRADE CERVICAL INTRAEPITHELIAL NEOPLASIA

Objective: To evaluate the serial changes in colposcopic and cervicogr aphic findings of women with cervical intraepithelial neoplasia (GIN) II and III enrolled in a phase III randomized comparison of oral beta carotene and placebo. Methods: All subjects treated with beta carotene or placebo for at least 6 months were included if they met the criter ia of persistent or progressive disease (no change or worsening of CIN grade) or disease regression (improvement of two grades or more). The se two groups were compared for changes in colposcopic and cervicograp hic patterns. Colposcopically directed biopsies and cervicography were done at enrollment and after 6 months. Quarterly Fapanicolaou smears and colposcopic assessments also were performed. Findings of mosaic pa ttern, punctation, and white epithelium were graded and diagrammed at colposcopic examinations. Cervicographic measurements of the centripet al movement of metaplastic epithelium were recorded. Data were analyze d by chi(2) analysis and Fisher exact tests. Results: Data were availa ble for 23 subjects with regression and 16 with persistent lesions. Sm all lesions were significantly more likely to regress than large ones. Lesions without coarse punctation were significantly more likely to r egress than lesions with coarse punctation, and lesions with mild acet owhite changes were more likely to regress than those with dense white epithelium. A pattern of centripetal movement of the metaplastic epit helium toward the cervical os was noted in lesions that regressed, but not in those that persisted or progressed. Conclusion: This study des cribes the centripetal growth of metaplastic squamous epithelium assoc iated with the regression of CIN II and III. This observation contribu tes to our understanding of the process of disease regression in CIN a nd may be useful in identifying individuals for conservative managemen t. Failure to identify this pattern correlates with persistent or prog ressive disease. (C) 1997 by The American College of Obstetricians and Gynecologists.