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Master Thesis

Suivi d’une cohorte de patientes porteuses d’une néoplasie malpighienne cervicale intra-épithéliale de haut grade (CIN2) : recherche de critères cliniques, virologiques et anatomo-pathologiques prédictifs de l’évolution

Abstract : Introduction: CIN2 regression is evaluated to occur in at least 40% of cases. However, the recommended conization of these lesions increases the risk of spontaneous abortion and preterm labor. A better knowledge of predictive evolution factors would allow restricting this treatment to patients with higher risk of pejorative evolution. Materials and methods: the first prospective cohort consists of 73 patients with CIN2 diagnosed on biopsy. They have been monitored to evaluate the clinical, virological, and pathological factors potentially predictive of evolution. The second retrospective cohort includes 59 patients who underwent conization following the diagnosis of CIN2. This cohort allowed us to evaluate the lesions present on the conization of patients with CIN2 biopsy and their possible predictive factors. Results: 56.2% of patients from the follow-up cohort are in regression/remission at the date of the latest news. The lesion observed on the initial smear shows an impact on the final status: significant difference between patients in remission/regression for "low grade" smears, and persistence/worsening with "high grade" smears (p=0,01). The patients whose biopsy does not present inflammation evolve towards a remission/regression of their lesion in 90% of the cases versus 51.7% of the cases where the biopsy is inflammatory (p=0,04). Patients with HPV HR are more in remission/regression for non-HPV 16 than HPV 16 (66.7% versus 46.2% p=0,04). Conclusion: according to our work, active surveillance of CIN2 would be beneficial to more than one in two patients. Specifying the selection criteria for patients eligible for surveillance (in particular initial smear and HPV genotyping) could allow this management for patients with CIN2.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01811527
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Déborah Bercovici. Suivi d’une cohorte de patientes porteuses d’une néoplasie malpighienne cervicale intra-épithéliale de haut grade (CIN2) : recherche de critères cliniques, virologiques et anatomo-pathologiques prédictifs de l’évolution. Médecine humaine et pathologie. 2018. ⟨dumas-01811527⟩

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