Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and the Departments of Pathology and Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Obstet Gynecol. 2020 Sep;136(3):510-517. doi: 10.1097/AOG.0000000000003982.
To compare the proportion of cervical intraepithelial neoplasia (CIN) 2 or worse pathology among different risk strata according to the ASCCP when applied in women who had atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesion (LSIL) cervical cytology; to assess performance of colposcopy; and to assess the independent predictors for detected CIN 2 or worse pathology.
This is a secondary analysis of a previous prospective study, which included Thai women with ASC-US or LSIL cytology who underwent high-risk human papillomavirus (HPV) testing and subsequent colposcopy with directed biopsy. Patients were classified as lowest-risk, intermediate-risk, or highest-risk based on cervical cytology, high-risk HPV testing, and colposcopic impression. The proportion of CIN 2 or worse pathology and associated prognostic factors were analyzed.
Of 697 women, 103 (14.8%), 573 (82.2%) and 21 (3%) were classified into lowest-risk, intermediate-risk, and highest-risk groups, respectively. The proportion of CIN 2 or worse pathology was 1%, 11.2%, and 61.9% in those same groups, respectively (P<.001). Colposcopy to detect CIN 2 or worse pathology had a sensitivity, specificity, positive predictive value, and negative predictive value of 98.7%, 18%, 13.2%, and 99.1%, respectively. Independent predictors for detecting CIN 2 or worse pathology were positive high-risk HPV, HPV 16/18 positivity, and high-grade colposcopic impression.
This study supports a no biopsy with follow-up strategy in the lowest-risk group, inconsistent with ASCCP recommendations, but is in alignment with a strategy of multiple targeted biopsies in the intermediate-risk and highest-risk groups.
比较应用美国阴道镜和宫颈病理学会（ASCCP）标准时不同风险分层中宫颈上皮内瘤变（CIN）2 级或更高级别病变的比例，评估阴道镜的表现，并分析预测 CIN 2 级或更高级别病变的独立预测因素。
这是一项前瞻性研究的二次分析，纳入了细胞学检查为非典型鳞状细胞不能明确意义（ASC-US）或低度鳞状上皮内病变（LSIL）的泰国女性，这些患者均接受了高危型人乳头瘤病毒（HPV）检测及随后的阴道镜检查和定向活检。患者根据宫颈细胞学、高危型 HPV 检测和阴道镜印象分为低危、中危和高危。分析 CIN 2 级或更高级别病变的比例及相关预测因素。
697 例患者中，分别有 103（14.8%）、573（82.2%）和 21（3%）例患者被分到低危、中危和高危组。这三组的 CIN 2 级或更高级别病变比例分别为 1%、11.2%和 61.9%（P＜0.001）。阴道镜检查检测 CIN 2 级或更高级别病变的敏感性、特异性、阳性预测值和阴性预测值分别为 98.7%、18%、13.2%和 99.1%。预测 CIN 2 级或更高级别病变的独立预测因素是高危型 HPV 阳性、HPV16/18 阳性和高级别阴道镜印象。
本研究支持低危组采用不活检、随访的策略，与 ASCCP 建议不一致，但与中危和高危组采用多次靶向活检的策略一致。
