Using Patient History to Predict High-Grade Cervical Dysplasia and Cancer in Women with Borderline Cervical Cytologic Results

Abstract

To determine whether demographic and lifestyle factors can be used to triage women with borderline cervical cytologic results. Demographic and medical information were collected from women undergoing colposcopy for a cytologic result read as atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesion in the gynecology clinic of an urban public hospital between July 1, 1996, and December 1, 1999. Colposcopy and subsequent histologic results were reviewed. Multivariate analysis was used to define predictors of high-grade cervical disease. From among 1725 eligible women, 283 women (16%) with ASCUS or low-grade squamous intraepithelial lesion results were found to have high-grade cervical disease (113 women with ASCUS results [13%] and 170 women with low-grade squamous intraepithelial lesion results [21%]). In multivariate analysis, pregnant women were less likely to have high-grade disease (odds ratio, 0.36; 95% CI, 0.17-0.79). Women with three or more lifetime sexual partners were more likely to have high-grade disease (odds ratio, 1.75; 95% CI, 1.31-2.34). However, a triage scheme tracking pregnant women with fewer than three lifetime partners to observation without colposcopy would have excluded only 51 of the 1725 women eligible (3%). Other combinations of risk factors had inadequate sensitivity or specificity for high-grade disease. Separate models for ASCUS showed that only having fewer than three lifetime sexual partners was associated with lower risk of high-grade histologic results (odds ratio, 0.56; 95% CI, 0.36-0.89), but excluding women with fewer partners would have missed 27 of 110 cases (25%) of high-grade disease. History and demographic information are inadequately sensitive for use in triage of women with borderline cytologic findings. Colposcopy or triage using human papillomavirus DNA tests remain indicated.