Department of Pathology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA,
Faculty of Computer Science, Bialystok University of Technology, Bialystok, Poland.
Acta Cytol. 2021;65(2):158-164. doi: 10.1159/000511620. Epub 2020 Dec 1.
Cervical screening has decreased the incidence of cervical carcinoma around the world primarily by preventing cervical squamous carcinoma, with significantly less measurable protective benefits in prevention of cervical adenocarcinoma. In this study, we apply Bayesian modeling of cervical clinical, screening, and biopsy data from a large integrated health system to explore the feasibility of calculating personalized risk assessments on screened system patients for subsequent histopathologic diagnoses of invasive cervical adenocarcinoma (AdCa) or cervical adenocarcinoma in situ (AIS).
Diagnoses of cervical AIS or AdCa rendered between 2005 and 2018 were identified in our large health system database with 1,053,713 cytology results, 354,843 high-risk (hr) human papillomavirus (HPV) test results, and 99,012 cervical histopathologic results. Using our continuously updated Bayesian cervical cancer screening model which includes clinical data, cervical screening results, and cervical biopsy results, we projected quantitative estimates of patients' 5-year cumulative risk for cervical AIS or AdCa.
161 patients were identified with AIS (ages 17-75, mean 37 years), and 99 patients had diagnoses of cervical AdCa (ages 26-91, mean 48 years). Quantitative Bayesian 5-year cumulative risk projections for diagnoses of cervical AdCa or AIS in patients with different cervical screening test and biopsy histories were determined. The highest patient risk projections for subsequent cervical AdCa and/or AIS histopathologic diagnoses were associated with prior cervical screening test results of HPV-positive atypical glandular cells. Prior squamous cytologic abnormalities were associated with lower risk estimates. Prior histopathologic diagnoses of squamous abnormalities also influenced quantitative risk. A prior histopathologic diagnosis of AIS was associated with a very low risk of subsequent AdCa, consistent with effective excisional treatment. AdCa risk was greatest in women aged 30-65 years with prior CIN3 biopsy results, whereas AIS risk was greatest in women <30.
Prevention of cervical AdCa in screened patients remains a major challenge for cervical screening. Individualized risk projections for cervical glandular neoplasia reflecting patient age, prior cervical screening test results, and prior cervical biopsy history are feasible using Bayesian modeling of health system data.
宫颈筛查通过预防宫颈鳞状细胞癌，已在全球范围内降低了宫颈癌的发病率，而对预防宫颈腺癌的效果则小得多。在这项研究中，我们应用贝叶斯模型，对来自大型综合卫生系统的宫颈临床、筛查和活检数据进行分析，以探索在接受筛查的系统患者中计算个性化风险评估，从而预测后续浸润性宫颈腺癌（AdCa）或宫颈原位腺癌（AIS）的组织病理学诊断的可行性。
在我们的大型健康系统数据库中，我们确定了 2005 年至 2018 年期间的宫颈 AIS 或 AdCa 诊断，其中包括 1053713 例细胞学结果、354843 例高危（hr）人乳头瘤病毒（HPV）检测结果和 99012 例宫颈组织病理学结果。我们使用不断更新的贝叶斯宫颈癌筛查模型，该模型包含临床数据、宫颈筛查结果和宫颈活检结果，对患者 5 年累积宫颈 AIS 或 AdCa 风险进行定量估计。
确定了 161 例 AIS 患者（年龄 17-75 岁，平均 37 岁）和 99 例宫颈 AdCa 患者（年龄 26-91 岁，平均 48 岁）。确定了不同宫颈筛查试验和活检史患者诊断为宫颈 AdCa 或 AIS 的贝叶斯 5 年累积风险预测。与 HPV 阳性非典型腺细胞的宫颈筛查检测结果相关的是后续发生宫颈 AdCa 和/或 AIS 组织病理学诊断的最高患者风险预测。先前的鳞状细胞异常细胞学与较低的风险估计相关。先前的鳞状组织学异常诊断也会影响定量风险。先前的 AIS 组织学诊断与后续 AdCa 的极低风险相关，这与有效的切除治疗一致。在 30-65 岁有 CIN3 活检结果的女性中，AdCa 风险最大，而在<30 岁的女性中，AIS 风险最大。
预防筛查患者的宫颈腺癌仍然是宫颈筛查的主要挑战。使用健康系统数据的贝叶斯建模，可以为宫颈腺性肿瘤进行个体化风险预测，反映患者年龄、先前的宫颈筛查检测结果和先前的宫颈活检史。
