Management of women with low grade cytology: how reassuring is a normal colposcopy examination?

M E Cruickshank, S C Cotton, L Sharp, L Smart, L G Walker, J Little, The TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)


OBJECTIVES: To determine the rate of cervical intraepithelial neoplasia grade 2 (CIN2+) in women with low grade cervical cytology and a normal colposcopy examination over 3 years of follow-up.

DESIGN: Cohort study within a randomised controlled trial.

SETTING: NHS Cervical Screening Programmes in Grampian, Tayside and Nottingham.

POPULATION: Eight hundred and eighty-four women aged 20-59 years with borderline nuclear abnormalities (BNA) or mild dyskaryosis with a normal and adequate colposcopy examination.

METHODS: Samples at baseline were tested for 14 high-risk (Hr) types using GP5+6+ methodology and for HPV 16 and 18 using type-specific primers. Women were followed up post-colposcopy by cervical cytology at 6-month intervals in primary care. After 3 years, women were invited for an exit colposcopy examination and underwent LLETZ if any colposcopic abnormality was identified.

MAIN OUTCOME MEASURES: Absolute and relative risks of CIN2+ during follow-up and/or at exit colposcopy.

RESULTS: The median age was 36 years. The absolute risk of developing CIN2+ within 3 years was 1.86 per 100 woman years and for CIN3+, 0.64 per 100 woman years. One microinvasive cancer was identified. The relative risk (RR) was highest for women with initial mild dyskaryosis who were HrHPV-positive (RR 5.86, 95% confidence interval 2.53-13.56) compared with women with BNA who were HrHPV-negative.

CONCLUSION: For women with low grade cervical cytology, the risk of a high grade CIN within 3 years of a normal colposcopy examination is low. Women can be reassured that, even with a positive HPV test, the risk of developing CIN2 or worse is sufficiently low to return to the routine 3-year recall.

Original languageEnglish
Pages (from-to)380-386
Number of pages7
JournalBJOG-An International Journal of Obstetrics and Gynaecology
Issue number3
Early online date20 Jun 2014
Publication statusPublished - Feb 2015

Bibliographical note

Funded by
Medical Research Council. Grant Number: G9700808


  • Adult
  • Anxiety
  • Cervical Intraepithelial Neoplasia
  • Cervix Uteri
  • Cohort Studies
  • Colposcopy
  • Female
  • Follow-Up Studies
  • Great Britain
  • Humans
  • Mass Screening
  • Middle Aged
  • Quality Assurance, Health Care
  • Referral and Consultation
  • Uterine Cervical Dysplasia
  • Uterine Cervical Neoplasms
  • Vaginal Smears


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