Laval University, Quebec City, Quebec, Canada.
J Low Genit Tract Dis. 1999 Oct;3(4):239.
The percentage of women with atypical squamous cells of undetermined significance (ASCUS) with concomitant cervical intraepithelial neoplasia (CIN) is relatively high, varying between 18% and 30%, depending on the series. The objective of this study was to identify factors other than cervical human papillomavirus (HPV) infection that would help to identify women with newly diagnosed ASCUS and in need of referral to colposcopy.
A total of 360 eligible women in whom ASCUS was diagnosed and who were referred to the colposcopy clinic of Saint-Sacrement Hospital in Quebec City were included in this study (participation rate, 92%). Eligible women were those aged between 18 and 50 years, with newly diagnosed ASCUS, with no history of cervical biopsies or treatment, and not pregnant at the time of their visit. During their gynecological visit, a cell sample was collected for HPV testing, and colposcopically directed biopsies of lesions were obtained. HPVs were detected using the Digene hybrid capture test. Logistical regression was used to estimate odds ratios (ORs) for concomitant CIN and their 95% confidence intervals (CIs). All ORs were adjusted for cervical HPV infection and other risk factors.
Cervical HPV infection was the factor most strongly related to concomitant CIN (OR = 4.0; 95% CI = 2.2-7.3). After taking into account the presence of cervical HPV infection, two variables were significantly associated with concomitant CIN. Compared to older women, those aged 35 or younger had a higher risk of concomitant CIN (OR - 2.3; 95% CI - 1.3-4.2). Current smoking was positively associated with concomitant CIN (OR - 2.7; 95% CI - 1.4-5.1), while there was no association between past smoking and concomitant CIN. Having had more than four sexual partners in the last 5 years was associated with an OR of 2.1; however, this association did not reach statistical significance. Cervical HPV infection, younger age, and current smoking were independent determinants of both CIN1 and CIN2 and 3.
Age and smoking status are independent predictors of concomitant CIN in women with newly diagnosed ASCUS. When HPV testing is not available, clinicians could preferentially refer younger women and those who smoke to colposcopy, as they represent a population with ASCUS at high risk of concomitant CIN.
伴有宫颈上皮内瘤变（CIN）的不典型鳞状细胞意义不明确（ASCUS）患者的比例相对较高，在 18％至 30％之间变化，具体取决于系列。本研究的目的是确定除宫颈人乳头瘤病毒（HPV）感染以外的其他因素，以帮助识别新诊断为 ASCUS 并需要转诊行阴道镜检查的妇女。
本研究纳入了 360 名符合条件的被诊断为 ASCUS 并转诊至魁北克市圣沙克蒙医院阴道镜检查门诊的妇女（参与率为 92％）。符合条件的妇女年龄在 18 至 50 岁之间，新诊断为 ASCUS，无宫颈活检或治疗史，就诊时未怀孕。在妇科就诊期间，采集细胞样本进行 HPV 检测，并对病变进行阴道镜引导活检。使用 Digene 杂交捕获试验检测 HPV。使用逻辑回归估计同时发生 CIN 的比值比（OR）及其 95％置信区间（CI）。所有 OR 均针对宫颈 HPV 感染和其他危险因素进行了调整。
宫颈 HPV 感染是与同时发生 CIN 最密切相关的因素（OR = 4.0；95％CI = 2.2-7.3）。在考虑到宫颈 HPV 感染的存在后，有两个变量与同时发生 CIN 显著相关。与年龄较大的妇女相比，35 岁或以下的妇女同时发生 CIN 的风险更高（OR = 2.3；95％CI = 1.3-4.2）。当前吸烟与同时发生 CIN 呈正相关（OR = 2.7；95％CI = 1.4-5.1），而过去吸烟与同时发生 CIN 无关。在过去 5 年内有 4 个或更多性伴侣与 OR 为 2.1 相关，但未达到统计学意义。宫颈 HPV 感染，年龄较小和当前吸烟是新诊断为 ASCUS 的妇女同时发生 CIN1 和 CIN2 和 3 的独立决定因素。
年龄和吸烟状况是新诊断为 ASCUS 的妇女同时发生 CIN 的独立预测因子。当 HPV 检测不可用时，临床医生可以优先将年轻女性和吸烟女性转诊至阴道镜检查，因为她们是 ASCUS 伴有高并发 CIN 风险的人群。
