Post-Colposcopy Management and Progression Predictors of Biopsy-Proven CIN1 in Women Under 25 Years
Post-Colposcopy Management and Progression Predictors of Biopsy-Proven CIN1 in Women Under 25 Years
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DOI：
10.1016/j.jogc.2018.06.021
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发表时间：
2019-03-01
影响因子：
1.8
通讯作者：
Bentley, James R.
中科院分区：
文献类型：
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作者：
Loopik, Diede L.;Bekkers, Ruud L. M.;Bentley, James R.
目的：回顾25岁以下女性宫颈上皮内瘤变1级(CIN1)阴道镜检查后的治疗和预后，并确定可能的预后因素。方法：对2010年1月1日至2012年12月31日在新斯科舍省哈利法克斯伊丽莎白二世医院阴道镜门诊就诊的25岁以下CIN1患者进行回顾性分析。结果：在326例经活检证实为CIN1的妇女中，234例(71.8%)重返常规筛查程序，92例在随访期间仍留在阴道镜检查诊所，中位随访时间为26个月。62%的妇女没有宫颈异常，23.6%的妇女有持续性的CIN1，14.4%的妇女有进展。8%的患者进展到CIN2，中位时间为13个月，而6.4%的患者在中位时间17.5个月内进展到CIN3+。病变范围(危险比2.33；95%可信区间1.17~4.64，P=0.02)和初诊时巴氏试验结果(危险比2.16；95%可信区间1.22~3.82，P=0.008)与肿瘤进展到CIN2+显著相关。结论：根据CIN3+的6%风险和进展的中位时间17.5月，12个月的细胞学随访似乎是可以接受的。首次就诊时的病变范围和巴氏试验结果被确定为CIN1进展的危险因素。
Objective: The post-colposcopy management and outcome of cervical intraepithelial neoplasia grade 1 (CIN1) in women under 25 years of age was reviewed, and potential predictors for progression were identified.Methods: Women under 25 with biopsy-proven CIN1 between January 1, 2010, and December 31, 2012 who were seen in the colposcopy clinic at the Queen Elizabeth II Hospital in Halifax, Nova Scotia were retrospectively reviewed. The regression, persistence, and progression rates of CIN1 were evaluated, and the relevant behavioural and biologic factors were reviewed.Results: Of the 326 women with a biopsy-proven CIN1, 234 (71.8%) women returned to the regular screening program, and 92 women remained in the colposcopy clinic during follow-up, with a median follow-up time of 26 months. Sixty-two percent of the women had no cervical abnormality, 23.6% of the women had persistent CIN1, and 14.4% of the women showed progression. Eight percent showed progression to CIN2 with a median time of 13 months, whereas 6.4% showed progression to CIN3+ within a median time of 17.5 months. The extent of the lesion (hazard ratio 2.33; 95% CI 1.17-4.64, P = 0.02) and the Pap test result at the initial visit (hazard ratio 2.16; 95% CI 1.22-3.82, P= 0.008) were significantly associated with progression to CIN2+.Conclusion: On the basis of the 6% risk of CIN3+ and the median time to progression of 17.5 months, follow-up with cytology at 12 months seems acceptable. The extent of the lesion and the Pap test result at the initial visit were identified as risk factors for progression of CIN1.