Article type
Year
Abstract
Objective: To conduct a systematic overview and meta-analysis of published and unpublished studies on the natural history of cervical dysplasia (dyskaryosis) and to estimate pooled rates for the probability of progression and regression of dysplasia without treatment.
Methods: Studies were identified from a Medline search of the English language literature. Additional studies were located from a search of the references of identified studies, review articles, textbooks, a search of the Federal Research in Progress Database, and contacts with experts in the field. Studies meeting pre-determined follow-up criteria were abstracted and quality assessment performed. A random effects model was used to pool studies, stratified by grade of dysplasia.
Results: Of 309 potentially relevant studies were identified, 38 studies including 10,778 patients met the predetermined criteria of a minimum of 6 months follow-up, and reporting rates for progression and regression. Overall study quality was poor, particularly due to subject loss to follow-up and inadequate reporting of follow-up duration. Pooled estimates for atypia/low grade dysplasia (mild dyskaryosis) were 2.5% (95%CI 0.4% - 4-5%) for progression and 48.1% (35.3% - 61.0%) for regression. The regression rate was inversely related to study quality score. For higher grade dysplasia (moderate-severe dyskaryosis), the pooled progression rate was 4.0% (0.8% - 7.2%) and the pooled regression rate was 40.8% (23.7% -57.9%).
Discussion: Our results are consistent with clinical policies for more aggressive follow-up of higher grade pap smear abnormalities. There appears to be a high probability for spontaneous regression of all grades of dysplasia. Future studies should emphasize and clearly report patient follow-up.
Methods: Studies were identified from a Medline search of the English language literature. Additional studies were located from a search of the references of identified studies, review articles, textbooks, a search of the Federal Research in Progress Database, and contacts with experts in the field. Studies meeting pre-determined follow-up criteria were abstracted and quality assessment performed. A random effects model was used to pool studies, stratified by grade of dysplasia.
Results: Of 309 potentially relevant studies were identified, 38 studies including 10,778 patients met the predetermined criteria of a minimum of 6 months follow-up, and reporting rates for progression and regression. Overall study quality was poor, particularly due to subject loss to follow-up and inadequate reporting of follow-up duration. Pooled estimates for atypia/low grade dysplasia (mild dyskaryosis) were 2.5% (95%CI 0.4% - 4-5%) for progression and 48.1% (35.3% - 61.0%) for regression. The regression rate was inversely related to study quality score. For higher grade dysplasia (moderate-severe dyskaryosis), the pooled progression rate was 4.0% (0.8% - 7.2%) and the pooled regression rate was 40.8% (23.7% -57.9%).
Discussion: Our results are consistent with clinical policies for more aggressive follow-up of higher grade pap smear abnormalities. There appears to be a high probability for spontaneous regression of all grades of dysplasia. Future studies should emphasize and clearly report patient follow-up.