Medicity Research Laboratory and Department of Oral Pathology, Institute of Dentistry, Faculty of Medicine, University of Turku, Finland.
Acta Obstet Gynecol Scand. 2011 Feb;90(2):167-73. doi: 10.1111/j.1600-0412.2010.01029.x. Epub 2010 Dec 7.
To study the incidence times and rates for cervical intraepithelial neoplasia (CIN) and its predictors.
This is a prospective follow-up study at Turku University Hospital, Finland. The Finnish Family human papillomavirus (HPV) study comprised 329 pregnant women followed up for 3 years. In an extension of the follow-up period, 171 women participated in an additional 3 years follow-up. Cervical scrapings for HPV testing and cervical smears were collected at each follow-up visit (2, 12, 24 and 36 months and 6 years). Following two abnormal cervical smears, colposcopy with biopsies was done. The main outcome measures were actuarial and crude incidence times, incidence rates and predictors of incident CIN.
During the follow-up period, 10 women (3.2%) developed biopsy-confirmed CIN, and four presented with incident atypical squamous cells suggesting high-grade squamous intraepithelial lesion cytology. The CIN/squamous intraepithelial lesion developed in 74.5 and 66.3 months, with crude incidence rates of 13.4/1,000 and 15.1/1,000 women months at risk, respectively. In multivariate Poisson regression, independent predictors of incident CIN were as follows: high-risk HPV positive at baseline (incidence rate ratio = 5.54; 95% confidence interval 1.02-30.14, p= 0.048); type-specific high-risk HPV persistence during follow-up (incidence rate ratio = 5.84; 95% confidence interval 2.28-17.93, p= 0.0001); cervical smear cytologically diagnosed for atypical squamous cells of undetermined significance or worse at any follow-up visit (incidence rate ratio = 4.56; 95% confidence interval 2.37-8.78, p= 0.0001); and new sexual partner during follow-up (incidence rate ratio = 9.45; 95% confidence interval 1.90-46.97, p= 0.006).
The results indicate that combined use of cervical smear and HPV testing, with prompt referral to colposcopy, enables accurate detection of incident CIN well before progression to invasive cancer. In addition to baseline and persistent high-risk HPV, abnormal cervical smear and new sexual partner are key predictors of incident CIN.
研究宫颈上皮内瘤变（CIN）的发生率和发生率及其预测因素。
这是芬兰图尔库大学医院的一项前瞻性随访研究。芬兰家庭人乳头瘤病毒（HPV）研究包括 329 名孕妇，随访 3 年。在随访期延长期间，有 171 名妇女参加了另外 3 年的随访。在每次随访（2、12、24 和 36 个月和 6 年）时采集 HPV 检测和宫颈涂片的宫颈刮片。在两次异常宫颈涂片后，进行阴道镜检查和活检。主要观察指标为 CIN 的实际和粗发生率时间、发生率和预测因素。
在随访期间，有 10 名女性（3.2%）经活检证实患有 CIN，4 名女性出现高级别鳞状上皮内病变细胞学异常的非典型鳞状细胞。CIN/鳞状上皮内病变发生于 74.5 和 66.3 个月，粗发生率分别为每 1000 名妇女月 13.4/15.1 例。多变量泊松回归分析显示，CIN 的独立预测因素如下：基线时高危 HPV 阳性（发病率比=5.54；95%置信区间 1.02-30.14，p=0.048）；随访期间 HPV 持续存在（发病率比=5.84；95%置信区间 2.28-17.93，p=0.0001）；任何随访时宫颈涂片细胞学诊断为不典型鳞状细胞不明意义或更差（发病率比=4.56；95%置信区间 2.37-8.78，p=0.0001）；随访期间有新的性伴侣（发病率比=9.45；95%置信区间 1.90-46.97，p=0.006）。
结果表明，结合宫颈涂片和 HPV 检测，及时转诊阴道镜检查，可在进展为浸润性癌之前准确检测到 CIN。除基线和持续性高危 HPV 外，异常宫颈涂片和新的性伴侣是 CIN 发生的关键预测因素。
