Predicting regression of cervical intraepithelial neoplasia grade 2 in women under 25 years

Sykes, Peter; Simcock, Bryony; Innes, Carrie; Harker, Dianne; Williman, Jonathan; Whitehead, Martin; Griend, Rachael A. van der; Lawton, Beverley; Hibma, Merilyn; Fitzgerald, Peter; Dudley, Narena M.; Petrich, Simone; Eva, Lois; Bergzoll, Cecile; Kathuria, Jyoti; McPherson, Georgina; Tristram, Amanda; Faherty, Jim; Hardie, Donna; Robertson, A J; Robertson, Vicki; Pather, Selvan; Wrede, C. David; Gastrell, Flora; Fentiman, Gary; John, Mathias; White, E. Frances; Parker, Charla A.; Sadler, Lynn

doi:10.1016/j.ajog.2021.09.009

Cited by 14 publications

(10 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The prediction of cervical lesion regression or persistence was modest in terms of sensitivity and overall accuracy, even though it included factors associated with regression or persistence of cervical lesions [ 31 , 32 ], thus leaving treatment algorithms dependent on repeated examinations and testing. Moreover, these results indicate the need for inclusion of more sensitive tests, which can outperform the classical approaches.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Study on the Progression, Recurrence, and Regression of Cervical Lesions: Assessing Various Screening Approaches

Gisca,

Munteanu,

Vasilache

et al. 2024

JCM

View full text Add to dashboard Cite

(1) Background: The prediction of cervical lesion evolution is a challenge for clinicians. This prospective study aimed to determine and compare the predictive accuracy of cytology, HPV genotyping, and p16/Ki67 dual staining alone or in combination with personal risk factors in the prediction of progression, regression, or persistence of cervical lesions in human papillomavirus (HPV)-infected patients; (2) Methods: This prospective study included HPV-positive patients with or without cervical lesions who underwent follow-up in a private clinic. We calculated the predictive performance of individual tests (cervical cytology, HPV genotyping, CINtecPlus results, and clinical risk factors) or their combination in the prediction of cervical lesion progression, regression, and persistence; (3) Results: The highest predictive performance for the progression of cervical lesions was achieved by a model comprising a Pap smear suggestive of high-grade squamous intraepithelial lesion (HSIL), the presence of 16/18 HPV strains, a positive p16/Ki67 dual staining result along with the presence of at least three clinical risk factors, which had a sensitivity (Se) of 74.42%, a specificity of 97.92%, an area under the receiver operating curve (AUC) of 0.961, and an accuracy of 90.65%. The prediction of cervical lesion regression or persistence was modest when using individual or combined tests; (4) Conclusions: Multiple testing or new biomarkers should be used to improve HPV-positive patient surveillance, especially for cervical lesion regression or persistence prediction.

show abstract

Section: Discussionmentioning

confidence: 99%

A Prospective Study on the Progression, Recurrence, and Regression of Cervical Lesions: Assessing Various Screening Approaches

Gisca,

Munteanu,

Vasilache

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…In women with CIN2, others have reported that disease regresses in 50% of cases within two years [ 24 ]. In the patient cohort studied here, disease in at least 53% of the women under 25 with CIN2 spontaneously regressed [ 25 ]. Importantly, progression was more likely in HPV16/18 infection than with other hr HPV types.…”

Section: Discussionmentioning

confidence: 99%

The High-Risk Human Papillomavirus Type Influences the Tissue Microenvironment in Cervical Intraepithelial Neoplasia Grade 2

Saito,

Rajesh,

Innes

et al. 2023

Viruses

Self Cite

View full text Add to dashboard Cite

High-risk, cancer-causing human papillomavirus (HPV) types are associated with cervical precancer and cancer. A high proportion of high-risk HPV precancer lesions undergo immune-mediated regression. The purpose of this study was to determine if the tissue microenvironment of HPV16 and 18 (HPV16/18) cervical intraepithelial neoplasia grade 2 lesions differed from other high-risk types (HPV ‘other’). Consistent with other studies, we found that progression to higher-grade disease was more frequent in HPV16/18 lesions when compared with HPV ‘other’ lesions. HPV16/18 lesions were significantly more likely to be indoleamine 2,3,-dioxygenase 1 (IDO1)-positive and were associated with reduced CD8 and FoxP3 T cells in the lesion. In the stroma, reduced Tbet- and CD32-positive cells and increased Blimp1-positive cells were significantly associated with HPV16/18 lesions when compared with HPV ‘other’ types. On analysis of the IDO1-positive tissues, lesional IDO1 was associated with significantly decreased numbers of CD4-, CD8-, and FoxP3-positive cells in the stroma compared with IDO1-negative tissues. These data suggest that IDO1 expression may impair infiltration of CD4, CD8, and FoxP3 cells into the stroma beneath the precancer lesion. Increased expression of IDO1 may contribute to immune avoidance and an increased frequency of disease progression in HPV16- and 18-positive lesions.

show abstract

“…Even though endocervical margin involvement has been found to be a risk factor for treatment failure, an observational cohort study by Ang C. et al discovered that the recurrence rate in a subgroup of women ≤ 35 years of age was similar in specimens of < 10 mm versus ≥ 10 mm length despite a higher rate of involved endocervical margins when excising < 10 mm [ 32 ]. Therefore, a possible approach in women with a wish to conceive could be to offer an excision length below 10 mm regardless of TZ, with a mandatory HPV test conducted 6 months after LLETZ, specifically considering that post-treatment HPV testing is known to have a higher sensitivity to predict residual or recurrent disease than margin status (91.0% versus 55.8%) [ 19 , 33 ]. It is noteworthy that in women with suspected invasive and/or glandular disease, this approach cannot be advised generally given the indisputable importance for oncological safety in those particular cases.…”

Section: Discussionmentioning

confidence: 99%

Rate of Involved Endocervical Margins According to High-Risk Human Papillomavirus Subtype and Transformation Zone Type in Specimens with Cone Length ≤ 10 mm versus > 10 mm—A Retrospective Analysis

Paternostro,

Joura,

Ranftl

et al. 2023

Life

View full text Add to dashboard Cite

The aim of this study was to evaluate the endocervical margin status according to transformation zone (TZ) and high-risk HPV (hr-HPV) subtype in specimens with cone length ≤ 10 mm versus > 10 mm to provide data for informed decision making and patients counseling especially for women wishing to conceive. In this retrospective cohort study, 854 patients who underwent large loop excision of the transformation zone during a nine-year period (2013–2021) for cervical disease were analyzed. The main outcome parameters were excision length, histological result, TZ type, HPV subtype and endocervical margin status. A subgroup analysis was performed according to excision length, with a cut-off value of 10 mm. A two-step surgical procedure was performed in case of an excision length of > 10 mm. The overall rate of positive endocervical margins irrespective of excision length was 17.2%, with 19.3% in specimens with ≤ 10 mm and 15.0% with > 10 mm excision length. Overall, 41.2% of women with a visible TZ and HPV 16/hr infection and 27.0% of women with HPV 18 received an excisional treatment of > 10 mm length without further oncological benefit, respectively. In contrast, assuming that only an excision of ≤ 10 mm length had been performed in women with visible TZ, the rate of clear endocervical margins would have been 63.7% for HPV 16/hr infections and 49.3% for HPV 18 infections. In conclusion, the decision about excision length should be discussed with the patient in terms of oncological safety and the risk of adverse pregnancy events. An excision length > 10 mm increases the number of cases with cervical tissue removed without further oncological benefit, which needs to be taken into account in order to provide an individual therapeutic approach. Furthermore, HPV 18 positivity is related to a higher rate of positive endocervical margins irrespective of TZ.

show abstract

Predicting regression of cervical intraepithelial neoplasia grade 2 in women under 25 years

Cited by 14 publications

References 39 publications

A Prospective Study on the Progression, Recurrence, and Regression of Cervical Lesions: Assessing Various Screening Approaches

A Prospective Study on the Progression, Recurrence, and Regression of Cervical Lesions: Assessing Various Screening Approaches

The High-Risk Human Papillomavirus Type Influences the Tissue Microenvironment in Cervical Intraepithelial Neoplasia Grade 2

Rate of Involved Endocervical Margins According to High-Risk Human Papillomavirus Subtype and Transformation Zone Type in Specimens with Cone Length ≤ 10 mm versus > 10 mm—A Retrospective Analysis

Contact Info

Product

Resources

About