Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada.
Cancer Prevention, Cancer Care Ontario, Toronto, Ontario, Canada.
J Low Genit Tract Dis. 2024 Jan 1;28(1):7-11. doi: 10.1097/LGT.0000000000000765. Epub 2023 Oct 30.
To determine the baseline and cumulative risk of cervical intraepithelial neoplasia (CIN)3 and invasive cervical cancer in participants referred to colposcopy with high-grade cytology and <CIN2 histology, stratified by biopsy result.
The authors linked administrative databases including cytology, pathology, cancer registries, and physician billing history to identify participants referred to colposcopy between January 2012 and December 2013 with high-grade cytology (atypical squamous cells [ASC]-H, high-grade squamous intraepithelial lesion [HSIL], invasive squamous cell carcinoma, adenocarcinoma, atypical glandular cells [AGC], adenocarcinoma in situ) and had <CIN2 (with and without biopsy confirmation) at colposcopy. Three- and 5-year risks of CIN3 and invasive cervical cancer were generated using Kaplan-Meier survival analysis.
Among 4,168 women referred to colposcopy for ASC-H, HSIL, squamous cell carcinoma, or adenocarcinoma, the 3- and 5-year CIN3 incidence rates were 17.7%/20.0% no biopsy, 13.0%/15.1% negative biopsy, and 18.9%/20.0% low-grade squamous intraepithelial lesion (LSIL) biopsies. The 3- and 5-year incidences of invasive cancer were: 1.25%/1.68% no biopsy, 0.78%/1.04% negative biopsy, and 0%/0% LSIL biopsy. When the initial cytology was AGC/adenocarcinoma in situ (n = 944), the 3- and 5-year rates of CIN3 were 7.42%/8.39% no biopsy, 7.41%/9.26% negative biopsy, and 7.69%/7.69% LSIL biopsy. The invasive cancer rates were 1.12%/1.54% no biopsy, 0.46%/0.46% negative biopsy, and 0.0%/0.0% LSIL biopsy. By screening cytology, participants referred for HSIL had the highest 3- and 5-year rates of CIN3 (18.9% and 21%) compared with AGC (7.22%/8.28%) and ASC-H (15.5%/18%). The 3- and 5-year invasive cancer rates were 1.38%/1.75% HSIL, 0.85%/1.17% AGC, and 0.91%/1.36% ASC-H.
In participants referred for high-grade cytology where colposcopy shows <CIN2, the subsequent risk of invasive cancer at 5 years is sufficiently elevated to warrant close surveillance in colposcopy.
根据活检结果对因高级别细胞学检查（非典型鳞状细胞[ASC]-H、高级别鳞状上皮内病变[HSIL]、浸润性鳞状细胞癌、腺癌、非典型腺细胞[AGC]、原位腺癌）且组织学检查 <CIN2 的患者进行分层，以确定转诊行阴道镜检查的患者中基线和累积的宫颈上皮内瘤变（CIN）3 及浸润性宫颈癌风险。
作者通过链接细胞学、病理学、癌症登记处和医生计费记录等管理数据库，确定了 2012 年 1 月至 2013 年 12 月间因高级别细胞学（ASC-H、HSIL、鳞状细胞癌或腺癌）转诊阴道镜检查的患者，并在阴道镜检查时发现组织学 <CIN2（有无活检证实）。采用 Kaplan-Meier 生存分析计算 CIN3 和浸润性宫颈癌的 3 年和 5 年风险。
在因 ASC-H、HSIL、鳞状细胞癌或腺癌而转诊行阴道镜检查的 4168 名女性中，无活检者的 3 年和 5 年 CIN3 发生率分别为 17.7%/20.0%，阴性活检者分别为 13.0%/15.1%，低级别鳞状上皮内病变（LSIL）活检者分别为 18.9%/20.0%。浸润性癌的 3 年和 5 年发生率分别为：无活检者分别为 1.25%/1.68%，阴性活检者分别为 0.78%/1.04%，LSIL 活检者均为 0%/0%。当最初的细胞学检查为 AGC/原位腺癌（n=944）时，无活检者的 3 年和 5 年 CIN3 发生率分别为 7.42%/8.39%，阴性活检者分别为 7.41%/9.26%，LSIL 活检者分别为 7.69%/7.69%。浸润性癌的发生率分别为无活检者分别为 1.12%/1.54%，阴性活检者分别为 0.46%/0.46%，LSIL 活检者均为 0.0%/0.0%。根据筛查细胞学检查，与 AGC（7.22%/8.28%）和 ASC-H（15.5%/18%）相比，因 HSIL 转诊的患者的 3 年和 5 年 CIN3 发生率最高（18.9%和 21%）。3 年和 5 年浸润性癌发生率分别为 HSIL 为 1.38%/1.75%，AGC 为 0.85%/1.17%，ASC-H 为 0.91%/1.36%。
在因高级别细胞学检查且阴道镜检查显示 <CIN2 而转诊的患者中，5 年内发生浸润性宫颈癌的风险升高，足以进行密切的阴道镜监测。
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