Subsequent risks for cervical precancer and cancer in women with low-grade squamous intraepithelial lesions unconfirmed by colposcopy-directed biopsy: results from a multicenter, prospective, cohort study (original) (raw)
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American Journal of Obstetrics and Gynecology, 2003
The purpose of this study was to determine the risk of cumulative cervical intraepithelial neoplasia (CIN) grade 2 or 3 according to initial colposcopy and directed biopsy results among women with low-grade squamous intraepithelial lesions (LSIL) or human papillomavirus (HPV) DNA positive atypical squamous cells of undetermined significance (ASCUS). A 2-year follow-up of 897 cases of LSIL and 1193 cases of HPV DNA positive ASCUS from the ASCUS/LSIL Triage Study was used to simulate American Society for Colposcopy and Cervical Pathology Consensus Conference recommendations. Women with CIN grade 1 or less were followed up for 2 years by semiannual cytologic examination, with universal exit colposcopy. The clinical end point was a cumulative clinical center histologic diagnosis of CIN grade 2 or 3. The cumulative risk of CIN grade 2 or 3 was equivalent for LSIL (27.6%) and HPV positive ASCUS (26.7%). After excluding the women with a diagnosis of CIN grade 2 or 3 at initial colposcopy and directed biopsy (17.9%), the remaining women were at nearly identical risk for subsequent CIN grade 2 or 3 regardless of initial colposcopy result (completely negative colposcopy-11.3%; negative colposcopically directed biopsy-11.7%; and CIN grade 1 biopsy-13.0%). LSIL and HPV positive ASCUS are clinically equivalent. Initial colposcopic detection of obviously prevalent CIN grade 2 or 3 reduces risk. However, for the remaining women who have CIN grade 1 or less on colposcopy and directed biopsy, the risk for subsequent CIN grade 2 or 3 (whether missed, prevalent, or truly incident) is approximately 12% over 2 years. This risk does not vary meaningfully by initial distinction of histologic CIN grade 1 from negative colposcopy and biopsy.
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 2017
Objective Expectant follow-up for biopsy-proven cervical intraepithelial neoplasia (CIN) 1 is the current recommendation for the management of this lesion. Nevertheless, the performance of the biopsy guided by colposcopy might not be optimal. Therefore, this study aimed to calculate the rate of underdiagnoses of more severe lesions in women with CIN 1 diagnosis and to evaluate whether age, lesion extent and biopsy site are factors associated with diagnostic failure. Methods Eighty women with a diagnosis of CIN 1 obtained by colposcopy-guided biopsy were selected for this study. These women were herein submitted to large loop excision of the transformation zone (LLETZ). The prevalence of lesions more severe than CIN 1 was calculated, and the histological diagnoses of the LLETZ specimens were grouped into two categories: "CIN 1 or less" and "CIN 2 or worse." Results The prevalence of lesions diagnosed as CIN 2 or worse in the LLETZ specimens was of 19% (15/80). Thr...
International Journal of Gynecological Cancer, 2006
The objective of this study was to determine the prevalence of high-grade histologic diagnoses in women who had low-grade squamous intraepithelial lesion (LSIL) on Pap smear in an area with high incidence of cervical cancer. We conducted a retrospective study of 220 women with LSIL cytology undergoing colposcopic examination in Chiang Mai University Hospital between January 1999 and July 2004. The histologic diagnoses, obtained from colposcopically directed biopsy or electrical loop excision after initial colposcopy, showed that 80 (36.4%) women had histologically confirmed high-grade lesions and 11 (5%) women had microinvasive (9) and frankly invasive (2) carcinomas. Overall, 41.5% of women with LSIL on Pap smear had significant underlying lesions, requiring appropriate treatment. In conclusion, in the region with high incidence of cervical cancer, women with LSIL cytology are at increased risk of having underlying high-grade lesions and invasive cancer. Immediate referral for colposcopy is warranted.
American Journal of Obstetrics and Gynecology, 2006
Objective: The purpose of this study was to determine the risk and presentation of cervical intraepithelial neoplasia (CIN) 3 or cancer after colposcopic diagnosis of CIN 1 or less. Study design: After colposcopy for an abnormal cytology, women with CIN 1 or less had annual cytology evaluations and high-risk human papillomavirus (HPV) tests (Hybrid Capture II). Colposcopy was repeated if the cytology result was ASC-H, or worse, ASC-US/high-risk HPV test positive, or every 2 years if the cytology was normal/high-risk HPV test positive. Differences in rates of CIN 3 or cancer were compared by log rank Kaplan-Meier survival analysis. Results: With median follow-up periods of 26.3 months, 47 of 2490 women (1.9%) with CIN 1 or less subsequently had CIN 3 or cancer. Subsequent CIN 3 or cancer was more likely if the highrisk HPV test was initially positive (45/1960 women [2.3%]) compared with negative (2/530 women [0.4%]; P = .0002) and if women were older (age R30 years, 28/1021 women [2.7%]; age 20-29 years, 17/1017 women [1.7%]; age !20 years, 2/452 women [0.4%]; P = .045). When CIN 3 or cancer was diagnosed, 45 of 46 women (97.8%) had positive high-risk HPV test and 42/46 women (91.3%) had an abnormal cervical cytology. The yield of CIN 3 or cancer per colposcopy for women (4/205 women [2.0%]) who had normal cervical cytology/positive high-risk HPV tests was lower than for women (41/541 women [7.6%]) who had abnormal cervical cytology/positive high-risk HPV tests (chi-square test, 8.3; P ! .005), and it did not increase with increasing length of follow-up. Conclusion: Annual cytology and high-risk HPV tests with colposcopy for high-risk HPV test positive/abnormal cytology and at least every 2 years for high-risk HPV test positive/normal cytology is advised after a colposcopic diagnosis of CIN 1 or less.
European Journal of Gynaecological Oncology
To define the relationship between the number of cervical colposcopic biopsies performed on a patient and the diagnosis of each grade of cervical intraepithelial neoplasia (CIN). Methods: Patients who underwent a colposcopy and biopsy between January and June 2018 in an Italian second-level checkpoint for cervical cancer screening were prospectively enrolled in the study. Cervical punch biopsies were performed on abnormal acetowhite areas that were identified by colposcopy and endocervical sampling was performed if needed. The number of cervical biopsies per patient was recorded along with the following parameters: type of transforming zone, colposcopic grading, Pap smear result, the patient's age, and endocervical sampling. All parameters were included in multivariable models. The dependent variable was a diagnosis of CIN-0/1, CIN-2, or CIN-3. Results: Independently of other variables, a Pap test result of atypical squamous cells-cannot be excluded H-SIL (ASC-H), atypical glandular cells, not otherwise specified (AGC-NOS), or high grade squamous intraepithelial lesion (H-SIL) is associated with reduced odds of a CIN-0 or CIN-1 diagnosis. More than one cervical biopsy per patient is associated with reduced odds of a CIN-0 or CIN-1 diagnosis whereas three or four biopsies is associated with increased odds of a CIN-2 diagnosis. A Pap test result of HSIL, ASC-H, or AGC-NOS is the only variable that increased the odds of a CIN-3 diagnosis. Discussion: A greater number of cervical biopsies performed on a patient increases the likelihood of diagnosing a CIN-2 but has no effect on the diagnoses of CIN-0/1 or CIN-3.
American Journal of Clinical Pathology, 2007
We examined the predictors (cytologic interpretations, pathology review, human papillomavirus [HPV] testing results, and colposcopic impressions) of precancer among 545 women with clinical center biopsy diagnoses of cervical intraepithelial neoplasia (CIN) 2 in the ASCUS LSIL Triage Study. Among women with a CIN 2 biopsy result, there was an increasing likelihood that the loop electrosurgical excision procedure (LEEP) tissue sample was diagnosed as precancer (CIN 3) with an increasing number of clinical risk factors of cervical precancer (high-grade squamous intraepithelial lesion [HSIL] cytology, high-grade colposcopy, detection of HPV type 16; P trend < .0005). In a multivariate model, using a case definition of worst histologic diagnosis made by the quality control pathology review of biopsy and LEEP tissue samples, HPV-16 was positively associated (odds ratio [OR], 4.8; 95% confidence interval [CI], 2.6-8.8) with a CIN 3 diagnosis, whereas testing negative for HPV or positive for noncarcinogenic HPV types was negatively associated (OR, 0.32; 95% CI, 0.14-0.75) with a CIN 3 diagnosis. Although we found clear evidence that HPV-16 detection helped clarify whether a biopsy specimen diagnosed as CIN 2 represented HPV infection or cervical precancer, this relationship was not sufficiently robust to be clinically useful for reducing the overtreatment of women with HPV infection.
Journal of Lower Genital Tract Disease, 2005
Adding a test for high-risk human papillomavirus (hrHPV) to cytological screening enhances the detection of high-grade cervical intraepithelial neoplasia (CIN2), but data are required that enable long-term evaluation of screening. We investigated the CIN2 risk for women participating in population-based screening as a function of hrHPV and cytology testing results at baseline and at 6 months. We included 2,193 women aged 30-60 years participating in a population-based screening trial who received colposcopy or a repeat testing advice at baseline. The main endpoint was histologically confirmed CIN2 diagnosed within 36 months. hrHPV testing was more sensitive than cytology for CIN2 (relative sensitivity 1.4, 95%CI: 1.3-1.5; absolute sensitivity 94.1 and 68.0%, respectively). The 18-month CIN2 risks in women with a hrHPV-positive smear and in women with abnormal cytology were similar (relative risk 0.9, 95%CI: 0.8-1.1). Women with HPV16 and/or HPV18 had a higher CIN2 risk than other hrHPV-positive women irrespective of the cytological grade. Repeat testing showed that both cytological regression and viral clearance were strongly associated with a decrease in CIN2 risk. Notably, women who had a double negative repeat test at 6 months had a CIN2 risk of only 0.2% (95%CI: 0.0-1.1) and hrHPV-negative women with baseline borderline or mild dyskaryosis and normal cytology at 6 months had a CIN2 risk of 0% (95%CI: 0.0-0.8). Using hrHPV and/or cytology testing, risk of CIN2 can be assessed more accurately by repeat testing than single visit testing. Hence, when hrHPV testing is implemented, patient management with repeat testing is a promising strategy to control the number of referrals for colposcopy.
BMJ Open
ObjectiveTo evaluate the risk of progression to high-grade squamous intraepithelial lesion (HSIL) (CIN2-3) or invasive cancer in women with histopathological diagnosis of low-grade squamous intraepithelial lesion (LSIL) (CIN1), managed in a long-term observational approach up to 5 years.DesignRetrospective cohort study.SettingFour tertiary referral hospital.Participants434 women with adequate colposcopy and complete colposcopic charts were included in the present analysis. Women with glandular lesions on the referral cytology or previous diagnosis of cervical dysplasia or invasive cervical cancer or with synchronous vaginal, or with HIV infection or immunodepression were excluded.Primary and secondary outcome measuresThe main study outcome was the rate of progression to histopathological HSIL (CIN2-3) or invasive cancer at any time during 5 years of follow-up. The possible risk factors were also evaluated. As secondary outcome, we analysed the possible risk factors at the 24-month e...
Medical Archives, 2012
A im of this study was to examine the frequency of cervical cancer and cervical intraepithelial lesions of a different degree in women, corelation between cytologically diagnosed CIN I, CIN II and CIN III lesions and colposcopic findings and corelation between cytologic and pathohistologic findings of CIN III lesion. Material and methods: Cytologic and colposcopic findings have been analysed retrospectively in 2652 women who went through systematic examinations in Women's Health Care Department at Health Center "Dr.Mustafa Šehovic" Tuzla in period 2008-2011. For 93.2% (N=2475) cytology results were normal. Abnormal cytology result was found in 6.71% (N=178): CIN I in 5.54% (147), CIN II in 0.67% (18) and CIN III in 0.49% (13) of women examined. Results and discussion: Colposcopy in women with cytology results CIN I, CIN II and CIN III showed abnormal result in women with CIN I in 29.9% (44/147), CIN II in 61.1% (11/18) and CIN III in 61.5% (8/13). Significant association between abnormal colposcopic and abnormal cytologic findings (X²=36.30,p<0.0005). Abnormal colposcopic result is twice as often with CIN II and CIN III changes on cervix in relation to CIN I. Byopsy of cervix in 13 women with CIN III pathohistologicaly confirmed the diagnose in 46.1% (4/13), cervix lesion was of higher degree in 30.8%, and in 23.0% (3/13) lesion of cervix was of a lower degree. Abnormal colposcopic image is an indicator for the abnormal cytological result. Conclusion: Systematic examination of women represents an efficient way of organized screening and prevention of cervical cancer.
Management of Colposcopy Patients with Biopsy-Proven Cervical Intraepithelial Neoplasia Grade 1
Journal of Lower Genital Tract Disease, 1999
T he optimal management of women with cervical intraepithelial neoplasia grade 1 (CIN1) diagnosed by colposcopically directed cervical biopsy is not clear. A 1997 survey of Ontario gynecologists confirmed this uncertainty, revealing that 46% of responding physicians immediately would treat the cervix of women with biopsy-proven CIN1 and that 42% would follow such women colposcopically and would treat only if the disease persisted or progressed (Dr. R. Osborne, personal communication).