Predictors of Absent High-grade Cervical Intraepithelial Neoplasia (CIN) in Loop Electrosurgical Excision Procedure Specimens of Patients with Colposcopic Directed Biopsy-Confirmed High-Grade CIN

Abstract

Objective:To determine predictors of having cervical intraepithelial neoplasia (CIN) 1 or less in loop electrosurgical excision procedure (LEEP) specimens of patients with colposcopic directed biopsy-confirmed CIN 2-3. Methods: Two hundred and eighty patients with colposcopic directed biopsy-confirmed CIN 2-3 who subsequently underwent LEEP were enrolled in the retrospective study. Related clinical data were collected to determine the predictors of CIN 1 or less in LEEP specimens. Results: CIN 1 or less in LEEP specimens was found in 71 (25.4%) of 280 patients. Multivariate logistic regression analyses demonstrated that nulliparity [OR (95% CI) = 3.375 (1.245-9.150)], low grade Papanicolaou (Pap) results [OR (95% CI) = 6.410 (2.877-14.280)] and low grade colposcopic impression [OR (95% CI) = 16.506 (5.844-46.632)] were significant risk factors of having CIN 1 or less in LEEP specimens. Neither persistent nor recurrent CIN 2-3 was detected in 71 patients who had CIN 1 or less in LEEP specimens. However, persistent or recurrent CIN 2-3 developed in 3 out of 209 (1.4%) patients with CIN 2-3 found in LEEP specimens. Conclusion: Approximately 25% of patients with CIN 2-3 in colposcopic directed biopsy specimens had CIN 1 or less found in LEEP specimens. Predicting factors of having CIN 1 or less in LEEP specimens were nulliparity, low grade Pap results and low grade colposcopic impression.

Absence of high-grade cervical intraepithelial neoplasia in conization specimens from patients with colposcopic biopsy-confirmed high-grade cervical intraepithelial neoplasia: Retrospective study of 1695 cases

“…Young women needed particular attention because conization could lead to cervical insufficiency. Previous studies have not found an association between age and an absence of high-grade dysplasia in conization specimens ( 13 , 14 , 20 ), which was possibly due to limited sample sizes and a lack of details regarding age groups. In this study, we found that patients aged 18–24 years were more likely to have an absence of high-grade dysplasia in conization specimens.…”

“…In our study, a significant percentage of patients (27.35%) initially diagnosed with CIN 2/3 were shown to have either no lesion or a grade of only CIN 1 after thorough examination of a conization specimen. Previous research reported that the corresponding rates ranged from 16% to 25% ( 9 , 12 – 14 ). The differences were related to conization indications and the definition of pathological discrepancy.…”

“…Poomtavorn et al. ( 14 ) reported that a low-grade Pap test result (a low-grade Pap test result included ASC-US and LSIL; a high-grade Pap test result included HSIL, ASC-H, AGC, and cancer) was a predictor of negative conization, with an OR of 6.410 (2.877, 14.280). We need to pay close attention to patients with preoperative negative hrHPV or non-HSIL cytology test results.…”

“…All patients with a negative cytology test result, a negative hrHPV test result, and, if available, a negative histology test result were considered as having no persistent/recurrent disease. After 2 consecutive years of negative results, these patients were followed up once a year ( 14 ).…”

“…Few studies have investigated the absence of high-grade CIN in excised specimens, and the sample sizes of these studies were limited. Moreover, there were some inconsistencies in the conclusions of these studies ( 12 – 14 ), and the clinical significance of this phenomenon has not been determined. This study retrospectively analyzed the clinical characteristics of 1695 patients diagnosed with CIN 2/3 in the Hubei Maternal and Child Health Hospital and Hubei Clinical Medical Research Center for Gynecologic Malignancy in the past 9 years.…”