Predictors of Concomitant Cervical Intraepithelial Neoplasia in Women with Newly Diagnosed Atypical Squamous Cells of Undetermined Significance

Abstract

Objective The percentage of women with atypical squamous cells of undetermined significance (ASCUS) with concomitant cervical intraepithelial neoplasia (CIN) is relatively high, varying between 18% and 30%, depending on the series. The objective of this study was to identify factors other than cervical human papillomavirus (HPV) infection that would help to identify women with newly diagnosed ASCUS and in need of referral to colposcopy. Materials and Methods A total of 360 eligible women in whom ASCUS was diagnosed and who were referred to the colposcopy clinic of Saint-Sacrement Hospital in Quebec City were included in this study (participation rate, 92%). Eligible women were those aged between 18 and 50 years, with newly diagnosed ASCUS, with no history of cervical biopsies or treatment, and not pregnant at the time of their visit. During their gynecological visit, a cell sample was collected for HPV testing, and colposcopically directed biopsies of lesions were obtained. HPVs were detected using the Digene hybrid capture test. Logistical regression was used to estimate odds ratios (ORs) for concomitant CIN and their 95% confidence intervals (CIs). All ORs were adjusted for cervical HPV infection and other risk factors. Results Cervical HPV infection was the factor most strongly related to concomitant CIN (OR = 4.0; 95% CI = 2.2–7.3). After taking into account the presence of cervical HPV infection, two variables were significantly associated with concomitant CIN. Compared to older women, those aged 35 or younger had a higher risk of concomitant CIN (OR - 2.3; 95% CI - 1.3–4.2). Current smoking was positively associated with concomitant CIN (OR - 2.7; 95% CI - 1.4–5.1), while there was no association between past smoking and concomitant CIN. Having had more than four sexual partners in the last 5 years was associated with an OR of 2.1; however, this association did not reach statistical significance. Cervical HPV infection, younger age, and current smoking were independent determinants of both CIN1 and CIN2 and 3. Conclusion Age and smoking status are independent predictors of concomitant CIN in women with newly diagnosed ASCUS. When HPV testing is not available, clinicians could preferentially refer younger women and those who smoke to colposcopy, as they represent a population with ASCUS at high risk of concomitant CIN.