Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON.
Cancer Care of Ontario, Toronto, ON.
J Obstet Gynaecol Can. 2022 Oct;44(10):1054-1060. doi: 10.1016/j.jogc.2022.06.012. Epub 2022 Aug 7.
To determine the baseline and cumulative risks of cervical intraepithelial lesion grade 3 (CIN3) and invasive cervical cancer in patients with <CIN2 colposcopy findings after a low-grade screening cytology finding (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion [LSIL]).
By linking administrative databases, including cytology, pathology, cancer registries, and physician billing history, a population-based cohort study was performed on participants with <CIN2 initial colposcopy results after a low-grade antecedent cytology finding, between January 2012 and December 2013. Three and 5-year risks of CIN3 and invasive cervical cancer were generated using Kaplan-Meier survival analysis.
Among the 36 887 participants included in the study, CIN3 incidence based on referral cytology were as follows at 3 and 5 years, respectively: normal, 0.7% and 0.9%; ASCUS, 4.31% and 5.6%; and LSIL, 5.9% and 7.2%. Three- and 5-year incidence of invasive cancer were 0% and 0.02% for normal cytology, 0.08% and 0.11% for ASCUS, and 0.04% and 0.07% for LSIL, respectively. Stratifying risk by biopsy result at initial colposcopy, 3- and 5-year CIN3 incidences were 2.85% and 3.81% with a negative biopsy, 7.09% and 8.32% with an LSIL biopsy, and 4.11% and 5.2% when no biopsy was done, respectively. Three- and 5-year incidence of invasive cancer was 0% and 0.05% after a negative biopsy, 0% and 0% after LSIL biopsy, and 0.05% and 0.08% when no biopsy was done, respectively.
When initial colposcopy is done after a low-grade screening cytology result and <CIN2 is identified, the risk of CIN3 and invasive cancer is low, particularly when biopsies indicate LSIL. Surveillance strategies should balance the likelihood of detecting CIN3 with the potential harms over management with too frequent screening or colposcopic interventions in low-risk patients.
确定在低级别筛查细胞学结果（非典型鳞状细胞意义不明确或低级别鳞状上皮内病变[LSIL]）后，<CIN2 阴道镜检查结果的患者中，宫颈上皮内瘤变 3 级（CIN3）和浸润性宫颈癌的基线和累积风险。
通过链接包括细胞学、病理学、癌症登记处和医生计费历史在内的行政数据库，对 2012 年 1 月至 2013 年 12 月期间进行低级别细胞学检查后初次阴道镜检查结果为 <CIN2 的患者进行了一项基于人群的队列研究。使用 Kaplan-Meier 生存分析生成 CIN3 和浸润性宫颈癌的 3 年和 5 年风险。
在纳入的 36887 名患者中，根据转诊细胞学检查，CIN3 的发病率如下：正常为 3 年时 0.7%，5 年时 0.9%；ASCUS 为 3 年时 4.31%，5 年时 5.6%；LSIL 为 3 年时 5.9%，5 年时 7.2%。正常细胞学的 3 年和 5 年浸润性癌症发病率分别为 0%和 0.02%，ASCUS 分别为 0.08%和 0.11%，LSIL 分别为 0.04%和 0.07%。根据初次阴道镜检查活检结果分层风险，阴性活检的 3 年和 5 年 CIN3 发生率分别为 2.85%和 3.81%，LSIL 活检的 3 年和 5 年 CIN3 发生率分别为 7.09%和 8.32%，未行活检的 3 年和 5 年 CIN3 发生率分别为 4.11%和 5.2%。阴性活检的 3 年和 5 年浸润性癌症发病率分别为 0%和 0.05%，LSIL 活检的 3 年和 5 年浸润性癌症发病率分别为 0%和 0%，未行活检的 3 年和 5 年浸润性癌症发病率分别为 0.05%和 0.08%。
当低级别筛查细胞学检查结果后进行阴道镜检查，且发现 <CIN2 时，CIN3 和浸润性宫颈癌的风险较低，尤其是当活检结果提示 LSIL 时。监测策略应平衡在低风险患者中进行过于频繁的筛查或阴道镜检查干预以检测 CIN3 的可能性与管理带来的潜在危害。
