Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2.
Evidence for frequent regression of cervical intraepithelial neoplasia-grade 2.
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DOI：
10.1097/aog.0b013e31818f5008
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发表时间：
2009-01
影响因子：
7.2
通讯作者：
Solomon D
中科院分区：
文献类型：
--
作者：
Castle PE;Schiffman M;Wheeler CM;Solomon D
使用意义未明的非典型鳞状细胞 (ASCUS) 和低度鳞状上皮内病变 (LSIL) 分类研究 (ALTS) 的数据来估计如果不治疗可能会消退的宫颈上皮内瘤变 2 (CIN-2) 的比例。我们比较了 ALTS 试验 2 年期间，三个试验组（立即阴道镜检查、人乳头瘤病毒 (HPV) 分类和保守治疗）中病理质量控制组诊断出的 CIN-2 (n = 397) 和 CIN-3 或更严重 (n = 542) 的累积发生率。使用非参数趋势检验来测试研究组中 CIN-2 病例数相对于 CIN-3 或更严重病例数的差异，基线时接受阴道镜检查的女性比例不断增加。研究组的 2 年累积 CIN-3 或更差诊断没有显着差异（10.9%，保守治疗；10.3%，HPV；10.9%，立即阴道镜检查）（ptrend = 0.8），但 CIN-2 诊断显着增加（5.8%，保守治疗；7.8%，HPV 分类；9.9%，立即阴道镜检查）（ptrend < 0.001）在研究中，越来越多的女性在基线时接受了阴道镜检查。基线时 HPV16 检测呈阳性的女性中，研究组的 CIN-2 相对差异 (ptrend = 0.1) 低于其他高危 HPV 基因型检测呈阳性的女性 (ptrend = 0.01)。有证据表明，大约 40% 的未确诊 CIN-2 会在 2 年内消退，但 HPV16 引起的 CIN-2 消退的可能性可能低于其他高危 HPV 基因型引起的 CIN-2。
To estimate the fraction of cervical intraepithelial neoplasia-2 (CIN-2) that might regress if untreated using data from the atypical squamous cells of undetermined significance (ASCUS) and low-grade squamous intraepithelial lesions (LSIL) triage study (ALTS). We compared the cumulative occurrence of CIN-2 (n = 397) and CIN-3 or worse (n = 542) diagnosed by the Pathology Quality Control Group in three trial arms— immediate colposcopy, human papillomavirus (HPV) triage, and conservative management— over the 2-year duration of the ALTS trial. A non-parametric test of trend was used to test for differences in the number of CIN-2 cases relative to number of CIN-3 or worse cases across study arms, with an increasing percentage of women referred to colposcopy at baseline. There were no significant differences in the cumulative 2-year cumulative CIN-3 or worse diagnoses by study arm (10.9%, conservative management; 10.3%, HPV; 10.9%, immediate colposcopy) (ptrend = 0.8) but there was a significant increase in CIN-2 diagnoses (5.8%, conservative management; 7.8%, HPV triage; 9.9%, immediate colposcopy) (ptrend < 0.001) in the study arms with increasing number of women referred to colposcopy at baseline. The relative differences in CIN-2 by study arm among women who tested HPV16 positive at baseline were less pronounced (ptrend = 0.1) than women who tested positive for other high-risk HPV genotypes (ptrend = 0.01). There was evidence that approximately 40% of undiagnosed CIN-2 will regress over 2 years but CIN-2 caused by HPV16 may be less likely to regress than CIN-2 caused by other high-risk HPV genotypes.