Abstract
Objective
To assess the risk of developing high-grade cervical dysplasia among women with low-grade cervical cytology and nonvisible squamocolumnar junction (SCJ) at colposcopic examination.
Methods
Data of consecutive women with low-grade intraepithelial lesion(<LSIL) undergoing colposcopic examination, which was unsatisfactory (due to the lack of the visualization of the entire SCJ), were retrospectively reviewed. The risk of developing high-grade cervical intraepithelial neoplasia (CIN2+) was assessed using Kaplan-Meier and Cox models.
Results
Data of 86 women were retrieved. Mean (standard deviation [SD]) age was 36.3 ( 13.4) years. A total of 71 (82.5%) patients had high-risk human papillomavirus (HR-HPV) at the time of diagnosis. Among the 63 patients undergoing repetition of HPV testing, 15 (24%) and 48 (76%) women had positive and negative tests for HR-HPV at 12 months, respectively. We observed that 5 (33%) of 15 patients with HPV persistence developed CIN2+, while only 1 (2%) patient of 48 patients without HPV persistence developed CIN2+ (odds ratio [OR]: 23.5; 95% confidence interval [CI]: 2.46-223.7; P <.001). The length of HR-HPV persistence correlated with an increased risk of developing CIN2+ (P<.001; P for trend). High-risk HPV persistence is the only factor predicting for CIN2+ (hazard ratio: 3.19; 95% CI: 1.55-6.57; P =.002).
Conclusions
High-risk HPV persistence predicts the risk of developing CIN2+ in patients with unsatisfactory colposcopic examination. Further studies are warranted in order to implement the use of HPV testing in patients with unsatisfactory colposcopy.
Similar content being viewed by others
References
Satterwhite CL, Torrone E, Meites E, et al. Sexually transmitted infections among US women and men: prevalence and incidence estimates, 2008. Sex Transm Dis. 2013;40(3):187–193.
Chesson HW, Dunne EF, Hariri S, Markowitz LE. The estimated lifetime probability of acquiring human papillomavirus in the United States. Sex Transm Dis. 2014;41(11):660–664.
Bogani G, Serati M, Cromi A, et al. Local anesthetic versus forced coughing at colposcopic-guided biopsy: a prospective study. Eur J Obstet Gynecol Reprod Biol. 2014;181:15–19. doi:10.1016/ j.ejogrb.2014.07.022.
Bornstein J, Bentley J, Bösze P, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012;120(1):166–172.
Makkar B, Batra S, Gandhi G, Zutshi V, Goswami D. Vaginal misoprostol versus vaginal estradiol in overcoming unsatisfactory colposcopy. Gynecol Obstet Invest. 2014;77(3):176–179. doi:10.1159/000358391.
Beniwal S, Makkar B, Batra S, Gandhi G, Goswami D, Zutshi V. Comparison of vaginal versus oral estradiol administration in improving the visualization of transformation zone (TZ) during colposcopy. J Clin Diagn Res. 2016;10(7):18–21.
International Agency for Research on Cancer, World Health Organization. Cervix Cancer Screening/IARC Handbooks of Cancer Prevention. Vol 10. Lyon, France: International Agency for Research on Cancer; 2005.
Bogani G, Martinelli F, Ditto A, et al. Human papillomavirus (HPV) persistence and HPV 31 predict the risk of recurrence in high-grade vaginal intraepithelial neoplasia. Eur J Obstet Gynecol Reprod Biol. 2017;210:157–165. doi:10.1016/j.ejogrb. 2016.12.020.
Koshiol J, Lindsay L, Pimenta JM, Poole C, Jenkins D, Smith JS. Persistent human papillomavirus infection and cervical neoplasia: a systematic review and meta-analysis. Am J Epidemiol. 2008; 168(2):123–137
Bogani G, Taverna F, Lombardo C, et al. Retrospective study of the influence of HPV persistence on outcomes among women with high-risk HPV infections and negative cytology. Int J Gynaecol Obstet. 2017;138(1):62–68.
Veiga FR, Russomano FB, Camargo MJ, Monteiro AC, Tristaão A, Silva GV. Prevalence of high-grade squamous intraepithelial lesions and cervical cancer among patients with unsatisfactory colposcopic examination, without visible lesion. Sao Paulo Med J. 2009;127(5):266–269.
El-Nashar SA, Shazly SA, Hopkins MR, Bakkum-Gomez JN, Famuyide AO. Loop electrosurgical excision procedure instead of cold-knife conization for cervical intraepithelial neoplasia in women with unsatisfactory colposcopic examinations: a systematic review and meta-analysis. J Low Genit Tract Dis. 2017;21(2):129–136.
Bogani G, Chiappa V, Martinelli F, Raspagliesi F. Type-specific HPV infection correlates with risk of recurrence of vulvar intrae-pithelial neoplasia usual type. Int J Cancer. 2017;140(7):1702. doi:10.1002/ijc.30585.
Bogani G, Martinelli F, Ditto A, et al. The association of pre-treatment HPV subtypes with recurrence of VIN. Eur J Obstet Gynecol Reprod Biol. 2017;211:37–41.
Ciapponi A, Bardach A, Glujovsky D, Gibbons L, Picconi MA. Type-specific HPV prevalence in cervical cancer and high-grade lesions in Latin America and the Caribbean: systematic review and meta-analysis. PLoS One. 2011;6(10):e25493
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bogani, G., Taverna, F., Lombardo, C. et al. Predicting Factors for High-Grade Cervical Dysplasia in Women With Low-Grade Cervical Cytology and Nonvisible Squamocolumnar Junction. Reprod. Sci. 26, 44–48 (2019). https://doi.org/10.1177/1933719118756747
Published:
Issue Date:
DOI: https://doi.org/10.1177/1933719118756747