The role of misclassification in progression of cervical intraepithelial neoplasia grade 2 during active…

Cohort studyAmerican journal of obstetrics and gynecology· Apr 2026

The role of misclassification in progression of cervical intraepithelial neoplasia grade 2 during active surveillance: results from a historical cohort.

Marie Brønd, Therese Christensen, Tina Hovgaard Randrup … Anne Hammer

Breast & Gynecologic PathologyCohort studyDiagnosisQ1IF 4.8

Expert-verified grade 3 diagnosis linked to higher risk of subsequent grade 3+ disease

The role of misclassification in progression of cervical intraepithelial neoplasia grade 2 during active surveillance: results from a historical cohort.

Marie Brønd … Anne Hammer

American journal of obstetrics and gynecology · Apr 2026

Background

Many countries have recently implemented active surveillance for cervical intraepithelial neoplasia grade 2 as an option in younger women due to high regression rates and because excisional treatment is associated with an increased risk of preterm birth.

Purpose

This study aimed to assess the association between expert-verified histological diagnoses of cervical biopsies in women undergoing active surveillance for cervical intraepithelial neoplasia grade 2 and the subsequent risk of cervical intraepithelial neoplasia grade 3 or worse.

Methods

We conducted a historical cohort study on women undergoing active surveillance for cervical intraepithelial neoplasia grade 2, diagnosed at Aarhus University Hospital from 2000 to 2010.

n = 437 women

Results

grade 3 diagnosis raised the risk of later grade 3+ disease versus grade 2

RR 1.37 (95% CI 1.07 to 1.75)

CI excludes the null - significant

More results

Upon expert review, 56 (12.8%) were upgraded to cervical intraepithelial neoplasia grade 3, 261 (59.7%) had cervical intraepithelial neoplasia grade 2 confirmed, and 120 (27.5%) were downgraded to cervical intraepithelial neoplasia grade 1/normal.

More results

Overall, 173 (39.6%) women had a subsequent record of cervical intraepithelial neoplasia grade 3 or worse, ranging from 22.5% in women with expert cervical intraepithelial neoplasia grade 1/normal, to 42.2% in women with expert cervical intraepithelial neoplasia grade 2, and 64.3% in women with expert cervical intraepithelial neoplasia grade 3.

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Conclusion · 1 of 2

Our findings demonstrate substantial interobserver variability in the diagnosis of community-detected cervical intraepithelial neoplasia grade 2, with nearly half of the cases being reclassified upon expert review.

Conclusion · 2 of 2

This underscores the heterogeneity of this diagnosis and the importance of accurate diagnosis to minimize both undertreatment and overtreatment.

The role of misclassification in progression of cervical intraepithelial neoplasia grade 2 during active surveillance: results from a historical cohort.

The role of misclassification in progression of cervical intraepithelial neoplasia grade 2 during active surveillance: results from a historical cohort.

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