Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy
Prospective follow-up suggests similar risk of subsequent cervical intraepithelial neoplasia grade 2 or 3 among women with cervical intraepithelial neoplasia grade 1 or negative colposcopy and directed biopsy
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DOI：
10.1067/mob.2003.461
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发表时间：
2003-06-01
影响因子：
9.8
通讯作者：
Solomon, D
中科院分区：
文献类型：
--
作者：
Cox, JT;Schiffman, M;Solomon, D
目的：本研究的目的是根据初次阴道镜检查和定向活检结果，确定患有低度鳞状上皮内病变（LSIL）或意义不明的人乳头瘤病毒（HPV）DNA阳性非典型鳞状细胞（ASCUS）的女性患累积性宫颈上皮内瘤变（CIN）2级或3级的风险。研究设计：对897例LSIL和宫颈癌患者进行为期2年的随访。使用 ASCUS/LSIL 分类研究中的 1193 例 HPV DNA 阳性 ASCUS 病例来模拟美国阴道镜学会和宫颈病理学共识会议的建议。患有 1 级或以下 CIN 的女性每半年进行一次细胞学检查，并使用通用出口阴道镜进行随访 2 年。临床终点是累积临床中心组织学诊断为 2 级或 3 级 CIN。 结果：2 级或 3 级 CIN 的累积风险与 LSIL (27.6%) 和 HPV 阳性 ASCUS (26.7%) 相当。排除初次阴道镜检查和定向活检时诊断为 2 级或 3 级 CIN 的女性 (17.9%) 后，无论初始阴道镜检查结果如何，其余女性后续发生 2 级或 3 级 CIN 的风险几乎相同（阴道镜检查完全阴性 - 11.3%；阴道镜定向活检阴性 - 11.7%；CIN 1 级活检 - 13.0%）。结论：LSIL 和 HPV 阳性ASCUS 在临床上是等效的。对明显流行的 2 级或 3 级 CIN 进行初始阴道镜检测可降低风险。然而，对于阴道镜检查和定向活检中 CIN 1 级或以下的其余女性来说，随后 2 级或 3 级 CIN（无论是漏诊、普遍还是真正发生）的风险在 2 年内约为 12%。根据组织学 CIN 1 级与阴性阴道镜检查和活检的初步区别，这种风险没有显着差异。
OBJECTIVE: The purpose of this study was to determine the risk of cumulative cervical intraepithelial neoplasia (CIN) grade 2 or 3 according to initial colposcopy and directed biopsy results among women with low-grade squamous intraepithelial lesions (LSIL) or human papillomavirus (HPV) DNA positive atypical squamous cells of undetermined significance (ASCUS).STUDY DESIGN: A 2-year follow-up of 897 cases of LSIL and 1193 cases of HPV DNA positive ASCUS from the ASCUS/LSIL Triage Study was used to simulate American Society for Colposcopy and Cervical Pathology Consensus Conference recommendations. Women with CIN grade 1 or less were followed up for 2 years by semiannual cytologic examination, with universal exit colposcopy. The clinical end point was a cumulative clinical center histologic diagnosis of CIN grade 2 or 3.RESULTS: The cumulative risk of CIN grade 2 or 3 was equivalent for LSIL (27.6%) and HPV positive ASCUS (26.7%). After excluding the women with a diagnosis of CIN grade 2 or 3 at initial colposcopy and directed biopsy (17.9%), the remaining women were at nearly identical risk for subsequent CIN grade 2 or 3 regardless of initial colposcopy result (completely negative colposcopy-11.3%; negative colposcopically directed biopsy-11.7%; and CIN grade 1 biopsy-13.0%).CONCLUSION: LSIL and HPV positive ASCUS are clinically equivalent. Initial colposcopic detection of obviously prevalent CIN grade 2 or 3 reduces risk. However, for the remaining women who have CIN grade 1 or less on colposcopy and directed biopsy, the risk for subsequent CIN grade 2 or 3 (whether missed, prevalent, or truly incident) is approximately 12% over 2 years. This risk does not vary meaningfully by initial distinction of histologic CIN grade 1 from negative colposcopy and biopsy.