Incidence risk of cervical intraepithelial neoplasia 3 or more severe lesions is a function of human papillomavirus genotypes and severity of cytological and histological abnormalities in adult Japanese women

Hosaka, Masayoshi; Fujita, Hiromasa; Hanley, Sharon J.B.; Sasaki, Takayuki; Shirakawa, Yozo; Abiko, Mitsuharu; Kudo, Masataka; Kaneuchi, Masanori; Watari, Hidemichi; Kikuchi, Kiyoko; Sakuragi, Noriaki

doi:10.1002/ijc.27680

Cited by 22 publications

(26 citation statements)

References 35 publications

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“…We identified 250 potentially eligible studies; 43 publications met the inclusion criteria (fig 1),6222324252627282930313233343536373839404142434445464748495051525354555657585960616263 but seven were duplicate reports of the same data 27283140505254. Of the 36 eligible studies (total of 3160 women), seven (19%) were randomised trials with suitable data in the non-experimental arm,22253339455762 16 (44%) were prospective cohort studies,6263032343536373841435155566063 and 13 (36%) were retrospective cohort studies23242942444647484953585961 (see supplementary table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 36 eligible studies (total of 3160 women), seven (19%) were randomised trials with suitable data in the non-experimental arm,22253339455762 16 (44%) were prospective cohort studies,6263032343536373841435155566063 and 13 (36%) were retrospective cohort studies23242942444647484953585961 (see supplementary table 2). The median follow-up was 16 months (range 3-72, interquartile range 7.6-27.4 months).…”

Section: Resultsmentioning

confidence: 99%

“…The protocols varied greatly between the studies, and of the 32 studies reporting the protocol, the definite criteria for colposcopic evaluation or histological sampling during the follow-up could not be defined in 11 studies. In the prospective, low risk of bias studies,22252630313335363738434751565763 the most typical protocols included cytology and colposcopy every three to four months, with routine biopsies or biopsies when progression was suspected.…”

Section: Resultsmentioning

confidence: 99%

“…Among the 3160 women, a total of 15 cases (0.5%, 15/3160) of cervical glandular intraepithelial neoplasia (cGIN; British Society of Colposcopy and Cervical Pathology classification—also known as adenocarcinoma in situ, AIS; Bethesda classification) were diagnosed during the follow-up period 425355. Fifteen cases of invasive cervical disease occurred (0.5%, 15/3160); 13 of stage 1A1 (0.4%, 13/3160) and two of more advanced invasive disease (0.06%, 2/3160) 23363739…”

Section: Resultsmentioning

confidence: 99%

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Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Tainio

Athanasiou

Tikkinen

et al. 2018

BMJ

255

242

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ObjectiveTo estimate the regression, persistence, and progression of untreated cervical intraepithelial neoplasia grade 2 (CIN2) lesions managed conservatively as well as compliance with follow-up protocols.DesignSystematic review and meta-analysis.Data sourcesMedline, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 1 January 1973 to 20 August 2016.Eligibility criteriaStudies reporting on outcomes of histologically confirmed CIN2 in non-pregnant women, managed conservatively for three or more months.Data synthesisTwo reviewers extracted data and assessed risk of bias. Random effects model was used to calculate pooled proportions for each outcome, and heterogeneity was assessed using I2 statistics.Main outcome measuresRates of regression, persistence, or progression of CIN2 and default rates at different follow-up time points (3, 6, 12, 24, 36, and 60 months).Results36 studies that included 3160 women were identified (seven randomised trials, 16 prospective cohorts, and 13 retrospective cohorts; 50% of the studies were at low risk of bias). At 24 months, the pooled rates were 50% (11 studies, 819/1470 women, 95% confidence interval 43% to 57%; I2=77%) for regression, 32% (eight studies, 334/1257 women, 23% to 42%; I2=82%) for persistence, and 18% (nine studies, 282/1445 women, 11% to 27%; I2=90%) for progression. In a subgroup analysis including 1069 women aged less than 30 years, the rates were 60% (four studies, 638/1069 women, 57% to 63%; I2=0%), 23% (two studies, 226/938 women, 20% to 26%; I2=97%), and 11% (three studies, 163/1033 women, 5% to 19%; I2=67%), respectively. The rate of non-compliance (at six to 24 months of follow-up) in prospective studies was around 10%.ConclusionsMost CIN2 lesions, particularly in young women (<30 years), regress spontaneously. Active surveillance, rather than immediate intervention, is therefore justified, especially among young women who are likely to adhere to monitoring.Systematic review registrationPROSPERO 2014: CRD42014014406.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Tainio

Athanasiou

Tikkinen

et al. 2018

BMJ

255

242

View full text Add to dashboard Cite

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“…A cohort study to estimate the risk of disease progression among the HPV genotypes in 570 Japanese women with cytologic low-grade squamous intraepithelial lesion (LSIL) and histologic CIN1/2 showed that the cumulative probability of CIN3 within 5 years was higher in HPV 16,18,31,33,35,52, and 58 than in the other hrHPV types [64]. Another Japanese cohort study on cytologic abnormalities, including ASC-US, LSIL, and HSIL (≤CIN2), reported that infection with HPV types 16, 18, and 33 posed a high risk of developing CIN3 [65]. The Japanese gynecologic guideline 2017 recommended HPV typing to evaluate the risk of disease progression for patients with histologically proven CIN1/2 (Figure 2).…”

Section: Hpv Typingmentioning

confidence: 99%

Secondary Prevention of Uterine Cervical Cancer

Sato¹,

Itamochi²

2018

Cervical Cancer - Screening, Treatment and Prevention - Universal Protocols for Ultimate Control

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Secondary prevention by cervical cytology has clearly improved the mortality rate of uterine cervical cancer (CC) by enabling early detection and treatment of high-grade squamous intraepithelial lesion (HSIL) or cervical intraepithelial neoplasia (CIN), which is a precancerous lesion. In the past two decades, HPV-DNA testing, including HPV typing, has clearly brought about positive effects on secondary prevention of CC. However, in practice, CC remains a fatal disease and is the second leading cause of cancer deaths in women aged 20-39 years. Although elucidation of the mechanisms of HPV carcinogenesis and development of a prophylactic vaccine have made CC a preventable disease, eradication of CC is expected to take several decades. Therefore, primary screening to decrease the mortality rate of CC will remain important for a while. In addition, the clinical application of simple biomarkers to stratify HPV-positive women is important for maintenance of medical economy and avoidance of overtreatment in women in the reproductive age. Therefore, the development of an inexpensive therapy or vaccine that can be used worldwide is necessary to overcome cancer deaths due to CC.

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Human papillomavirus type specific risk of progression and remission during long‐term follow‐up of equivocal and low‐grade HPV‐positive cervical smears

Vintermyr

Andersland

Bjørge

et al. 2018

Intl Journal of Cancer

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The prevalence of clinically relevant HPV types and their specific risk for progression and regression in women with atypical squamous cells of uncertain significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) were studied in a routine screening population. A 4-year cohort of women (n = 820) with ASCUS/LSIL and a positive HPV test in triage were followed for 6-9 years. The progression risks for CIN2+/CIN3+ were determined for single (71.2%) and multiple HPV infections (28.8%). The CIN2+ progression risk for all HPV 16, all HPV 35, single HPV 16 and single HPV 35 infections were 65.3% (95% CI: 59.6-71.0), 64.4% (95% CI: 50.4-78.4), 63.8% (95% CI: 56.2-71.4) and 73.7% (95% CI: 53.9-93.5), respectively. Based on CIN2+ progression risks four main groups were defined; the HPV 16 group, the HPV 31/33/35 group, the HPV 18/45/51/52 group and the HPV 39/56/58/59/66/68 group with progression risks of 65.3% (95% CI: 59.6-71.0), 62.1% (95% CI: 54.8-69.4), 52.6 (95% CI: 45.9-59.3) and 39.5 (95% CI: 33.0-46.0), respectively. In multivariate analyses, women in the age group 40-49 years had an increased risk of CIN2+ progression. As for CIN3+, HPV 16 had a higher progression risk than other HPV risk groups (p < 0.05). In multiple infections only HPV 16 had a significant additive CIN3+ progression risk (p < 0.05) as compared to other HPV risk groups. In summary, HPV types 16 and 35, including the HPV risk group 31/33/35, had a similar CIN2+ progression risk, but only HPV 16 had a higher risk for CIN3+ progression.

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Incidence risk of cervical intraepithelial neoplasia 3 or more severe lesions is a function of human papillomavirus genotypes and severity of cytological and histological abnormalities in adult Japanese women

Cited by 22 publications

References 35 publications

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: systematic review and meta-analysis

Secondary Prevention of Uterine Cervical Cancer

Human papillomavirus type specific risk of progression and remission during long‐term follow‐up of equivocal and low‐grade HPV‐positive cervical smears

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