GRADE I CERVICAL INTRAEPITHELIAL NEOPLASIA: PROGNOSIS AND MANAGEMENT TACTICS FOR PATIENTS

Objective. To substantiate clinical and morphological criteria for predicting the development of low-grade cervical intraepithelial neoplasia (CIN 1) for a differential approach to managing patients with this pathology. Subjects and methods. A cohort open prospective controlled study was conducted. Eighty-four patients with histologically verified CIN 1 (the f irst study point) were examined using PCR determination of HPV types 16 and 18, a colposcopic study, histological estimation of the extent of koilocytosis, and immunohistochemical determination of the expression of Ki-67, P53, P16ink4a. A control study was made 12 months later (the second study point); according to its results, the patients were divided into 3 groups: 1) CIN 1 regression; 2) persistent CIN 1; 3) progression to CIN 2. Groups 1 and 2 were compared at the first study point until predictive factors for the type of disease development were identified. Results. The Reid and Coppleson indices were used to find differences in the characteristics of colcoscopic patterns. In the persistent CIN 1 group, there were significantly more frequently cases of histologically diagnosed extensive koilocytosis and also differences in the expression of P16ink4a. The findings were employed to compile a diagnostic table for CIN 1 prognosis and to elaborate an algorithm for the management of patients with CIN 1. The economic efficiency of the proposed algorithm was proven. Conclusion. The study has yielded a new approach to managing patients with CIN 1, by applying the algorithm elaborated on the basis of a complex clinical and morphological analysis.

P16ink4a, cervical intraepithelial neoplasias, proliferation markers Ki-67, P16ink4a, Reid and Coppleson indices