Follow-up Compliance of Adolescents with Cervical Dysplasia in an Inner-city Population

Abstract 

Study Objective

Adolescent compliance with cytologic and histologic cervical abnormalities is poor. Recent changes in abnormal cytology follow-up and colposcopy indications in young women may delay the diagnosis of cervical dysplasia. The objective of our study was to determine the compliance with follow up. We also wanted to summarize regression or progression of disease, and to determine if the new guidelines could affect severity and time of diagnosis.

Design

Retrospective review of medical records from adolescent patients (defined as women aged 12 to 21) who had a colposcopy between January 2004 and December 2006. Patients were excluded if they were 22 or older or if they had a previously abnormal cytologic evaluation.

Main Outcome Measures

Colposcopy records between January 2004 and December 2006 were identified by CPT code from a computerized database. Cytology and histology results, follow-up compliance rates, and demographic data were collected. Data were analyzed with a power>85% and a P value ≤ .05 for significance.

Results

Of the 210 records reviewed, 61.9% had atypical squamous cells of undetermined significance high-risk HPV, 33.7% had low-grade squamous intraepithelial lesion, and 4.5% had high-grade squamous intraepithelial lesions. Colposcopy was performed in 55.9%, and 15.2% required surgical intervention. Loop electrosurgical excision procedure (LEEP) was used in 87.5% of patients, and 12.5% had a cold knife cone. Mean time to follow in patients with a surgical intervention was 12.72 months and 11.02 months for those without (P=.371).

Conclusion

There appears to be no difference in compliance with follow-up, regardless of severity of disease or surgical intervention. There was no significant progression of disease and a high regression rate of abnormalities. This information supports the current American College of Obstetricians and Gynecologists and American Society for Colposcopy and Cervical Pathology guidelines to delay aggressive intervention in adolescents.

Key Words: Adolescents, Pap smear, Compliance, Cervical dysplasia