Frequency Of Cervical Intraepithelial Neoplasia Research Articles

Pharmacological correction of immunological disorders in perimenopausal women with recurrent epithelial cervical dysplasia associated with human papillomavirus infection

Despite the successes achieved in implementing screening programs and treating diseases caused by human papillomavirus (HPV) infection, the frequency of cervical intraepithelial neoplasia (CIN) of moderate and high grades associated with high-risk human papillomavirus (HR-HPV) remains between 9% to 21%. Vaginal dysbiosis and the development of immunodeficient states due to persistent HR-HPV infection require effective immunomodulatory and antiviral therapy before cervical surgery in perimenopausal women with recurrent CIN II.The objective: to evaluate the effectiveness of antiviral and immunomodulatory therapy by determining the state of vaginal biocenosis, immunological status and papillomavirus load of the cervical mucosa before surgical treatment in perimenopausal women with recurrent CIN II.Materials and methods. A prospective study was conducted on 98 women aged 40 to 55 years old, including 60 patients with morphologically verified recurrent CIN II associated with high-risk HPV, forming the main group. The control group comprised 38 women with negative HPV test results and without significant gynecological or somatic pathology. In the main group, a complex consisting of a blend of plant extracts of sod pike grass (Deschampsia caespitosa), ground cinquefoil grass (Calamagrostis epigeios), and echinacea purpurea grass (Echinaceae purpureae) was administered orally.Vaginal microbiota was assessed using Hey-Іson criteria, and immunological status was examined in patients using solid-phase enzyme-linked immunosorbent assay to determine IgG, IgM, IgA antibodies in serum and cervical mucus, levels of interleukin-1β (IL-1β), interferons alpha (IFN-α), gamma (IFN-γ), tumor necrosis factor alpha (TNF-α). Additionally, the DNA of high-risk HPV in cervical mucosa was quantitatively assessed using real-time PCR. The investigations were conducted before and after the applied therapy.Results. The investigation of vaginal content revealed the presence of bacterial vaginosis in 65.0% of patients in the main group, the frequency of which decreased by 2 times after treatment, with the number of women with an intermediate type of vaginal content increasing by 2.8 times (51.7%) and those with normal microbiota increasing by 2.5 times. Disruptions in cellular and humoral immunity systems were identified. After treatment, there was an increase in viral load in the significant «threshold» category (3–5 lg) by 1.25 times and in the «above threshold for progression» category (>5 lg) by 2.3 times, reflecting natural HPV clearance. No direct correlation was found between viral load activity and the degree of CIN or positive morphological changes regarding regression of cervical intraepithelial lesions.Conclusions. The use of a complex containing a blend of plant extracts of sod pike grass (Deschampsia caespitosa), ground cinquefoil grass (Calamagrostis epigeios), and echinacea purpurea grass (Echinacea purpureae) improves the state of vaginal biocenosis, indicators of cellular and humoral immunity, and promotes HPV elimination, it has adequate safety and tolerability, which determines the feasibility of its use in the complex treatment of cervical intraepithelial neoplasia at the preparatory stage before surgery and in the postoperative period to prevent complications and relapses.

Cervical intraepithelial neoplasia: the current state of the problem in Yekaterinburg

Objective. To determine the frequency of cervical intraepithelial neoplasia among female citizens in Yekaterinburg. Materials and methods. The retrospective analysis of the report forms of the cervical pathology office in Yekaterinburg Perinatal Center from January to September 2022 was carried out. Statistical data processing was conducted using descriptive statistical methods in the Excel programme. Results. 255 cases of precancerous cervical diseases and 7 cases of cervical cancer were revealed within 9 months of monitoring, among them 24 patients with precancerous pathology and 4 with cervical cancer had previously been followed up by a specialist. Most cases of cervical pathology were revealed in patients over 40. Conclusions. The women's consultations of Verkh-Isetsky and Leninsky districts refer patients to the specialized cervical pathology office most actively. Patients of the cervical pathology office are provided with the full range of therapeutic and diagnostic procedures, with colposcopy being most often performed (27 % of cases). The dispensary group of patients of the cervical pathology office is mainly represented by women with cervical dysplasia of the 2nd degree (HSIL, CIN II) – 43.5 %.

Primary HPV-DNA screening in women under 30 years of age: health technology assessment

RESUMEN AntecedentesA partir del 2014 en Colombia se incorporó la tamización primaria con prueba de Virus del Papiloma Humano (VPH) desde los 30 hasta los 65 años, cuando la prueba es positiva se hace triage con citología para remisión a colposcopia. Actualmente se discute la conveniencia de iniciar la tamización con prueba de ADN de VPH a partir de los 25 años. De esta manera, el objetivo de esta evaluación de tecnologías sanitarias es analizar la evidencia disponible en torno a la seguridad, efectividad, costo-efectividad, valores y preferencias, dilemas éticos y aspectos relacionados con la implementación para el contexto colombiano de la prueba ADN-VPH como estrategia de tamización cervical en mujeres menores de 30 años.Dominios a evaluar Eficacia clínica y seguridad 1. Tasa acumulada de neoplasia intraepitelial cervical (NIC) grado 2 o más avanzado luego de 2 rondas de tamización.2. Tasas acumuladas de cáncer invasor de cérvix luego de 2 rondas de tamización.3. Seguridad: remisión a colposcopia. Costo-efectividad Costo efectividad para Colombia. Otros dominios considerados Aspectos éticos asociados a la tamización cervical en mujeres menores de 30 años. Aspectos organizacionales y del individuo. Barreras y facilitadores relacionados con la implementación en el contexto colombiano de la tamización cervical en mujeres menores de 30 años.Métodos Evaluación de efectividad y seguridad clínica Se realizó una búsqueda sistemática de la literatura en MEDLINE, Embase y CENTRAL de revisiones sistemáticas y ensayos clínicos. Se calificó el cuerpo de la evidencia con la aproximación GRADE. Posteriormente, se convocó a un grupo interdisciplinario a una mesa de trabajo en donde se presentó la evidencia recuperada, dando paso a la discusión y a la construcción de las conclusiones, siguiendo los lineamientos de un consenso formal acorde a la metodología RAND/UCLA. Estudio económico Se hizo una búsqueda sistemática de la literatura de estudios que hubieran evaluado el costo-efectividad para Colombia.ResultadosDe 7.659 referencias recuperadas se incluyeron 8 estudios. Resultados clínicos Se realizó un análisis integrativo de 5 ensayos clínicos aleatorizados que cumplieron con los citerios de inclusión. Cuando se compara frente a la citología, la tamización primaria con ADN-VPH en mujeres menores de 30 años, podría asociarse con una mayor frecuencia de detección de lesiones NIC2+ durante la primera ronda de cribado (RR: 1,57; IC 95 %: 1,20 a 2,04; certeza en la evidencia baja), con una menor incidencia de NIC2+ (RR: 0,67; IC 95 %: 0,48 a 0,92; certeza en la evidencia baja) y se asocia con una menor frecuencia de carcinoma invasor al término del seguimiento (RR: 0,19; IC 95 %: 0,07 a 0,53; certeza en la evidencia alta). Resultados económicos Desde el punto de vista económico, la alternativa de ADN-VPH y triage con citología desde los 25 años quizás representa la alternativa más costo-efectiva para Colombia (razón costo-efectividad incremental $8.820.980 COP año 2013). Otras implicaciones Dos estudios sugieren que las barreras de implementación, atribuibles a circunstancias de intermediación, de orden público y de carácter geográfico, podrían ser solventadas por nuevas tecnologías o estrategias de cribado. Es importante considerar alternativas de forma de administración y de prestación de servicios para solventar algunas barreras de aceptabilidad y acceso. Todo programa de tamización cervical debe contemplar los principios éticos de no maleficencia, beneficencia, autonomía y equidad. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.ConclusionesEl uso de la prueba ADN-VPH como estrategia de tamización en mujeres menores de 30 años es una intervención probablemente efectiva y costo-efectiva para Colombia. Futuros estudios deben enfocarse en analizar nuevas tecnologías de cribado con énfasis en población menor de 30 años.

Is there a Relationship between Combined Oral Contraceptive Use and Intrauterine Device Use with Abnormal Smear Results and Cervical Atypia?

Introduction: The relationship between the use of contraceptive method and the presence of Human Papilloma Virus (HPV) persistent infection and precancerous cervical lesions has not been fully established. Aim: To investigate the frequency of cervical atypia and risk factors affecting it in women using Combined Oral Contraceptive (COC) and Copper-Intrauterine Device Use (Cu-IUD). Materials and Methods: A retrospective study was conducted in a tertiary centre between 2017 to 2019, involving 835 patients using Cu-IUD and 538 patients using COC. Age, obstetric data, high-risk HPV type positivity, education level, location, occupation, Body Mass Index (BMI), smoking, cervical cytology results and colposcopic biopsy results were noted for each group. Statistical Package for the Social Sciences (SPSS) version 22.0 program was used to analyse the data. Pearson chi-square test and multivariate binary logistic regression test were performed. Model compatibility was good in binary logistics test (omnibus test p<0.001). The p<0.05 value was considered statistically significant. Results: The frequency of Cervical Intraepithelial Neoplasia l (CIN l) lesions increased in women using Cu-IUD (p=0.038), while the frequency of CIN II+ lesions increased in COC users. The use of COC increased the risk of CIN II+ (p=0.014). High-risk HPV type positivity was common in those using COC (p<0.05). In addition, age group 40-51 years, education level being primary, being multiparous, urban location, high risk HPV positivity were other risk factors for the presence of cervical atypia (p<0.05). Conclusion: The risk of CIN I increased in those using Cu-IUD, while the risk of CIN II+ increased in those using COC.

Incidencia de neoplasia intraepitelial cervical en pacientes que acuden a la Clínica de Patología de Cérvix en un hospital de Santo Domingo, República Dominicana, durante el período enero-diciembre 2014

Introducción: las neoplasias intraepiteliales cervicales (NIC) son lesiones precursoras del cáncer de cérvix. Aproximada-mente cada año se registran 527,600 nuevos casos, posicionándolo como el segundo cáncer más frecuente y la segunda causa mundial de muerte por cáncer en la mujer.
 Objetivo: determinar la incidencia de NIC en pacientes que acudieron a una Clínica de Patología de Cérvix de Santo Domingo, República Dominicana.
 Material y métodos: estudio retrospectivo, descriptivo y transversal en el cual se revisaron las historias médicas de 144 pacientes en riesgo de ser diagnosticadas con NIC durante el periodo.
 Resultados: la incidencia de NIC fue de 40.97 % (N=144). La NIC I fue el diagnóstico más frecuente con un 93.22 % (N=59), seguido 6.78 % con NIC II (N=59). Hubo una mayor frecuencia de NIC en las edades entre los 30 y 59 años (72.88 %, N=59). 62.71 % (N=59) presentó infección por virus del papiloma humano (VPH). La paridad en el 42.86 % (N=35) fue mayor de cuatro. 50 % (N=16) reportó como hábito tóxico el tabaquismo.
 Conclusiones: el diagnóstico de NIC predomina entre los 30 y 59 años, con una mayor frecuencia de NIC I. La infección por VPH, la paridad y el tabaquismo son factores que pudieran tener influencia sobre el desarrollo de la NIC.

Frequency of Cervical Intra-epithelial Neoplasia in Oral Contraceptive Pills Users in Zagazig University Hospitals

Frequency of Cervical Intra-epithelial Neoplasia in Oral Contraceptive Pills Users in Zagazig University Hospitals

Association between grade of referral smear and high-grade disease among women with biopsy samples showing cervical intraepithelial neoplasia grade 2.

To determine whether the grade of referral smear reflects the frequency of cervical intraepithelial neoplasia (CIN) grade 3 (CIN3) or worse lesions among patients with CIN2 on punch biopsy. In a retrospective study, data were reviewed from women with a punch biopsy sample showing CIN2 and a known referral smear who underwent large loop excision of the transformation zone (LLETZ) between January 1, 2013, and January 1, 2016, at Galway University Hospital, Ireland. Data were analyzed by patient age (≤30 and >30years), referral smear (low and high grade), and LLETZ histology (≤CIN2 and ≥CIN3). Overall, 264 women were included. LLETZ histology of CIN3 or worse was more common among women with high-grade referral smears (63/144 [43.8%]) than among those with low-grade smears (26/120 [21.7%]; relative risk 2.02, 95% confidence interval 1.37-2.96; P<0.001). Among patients younger than 30years, underlying CIN3 and above was again more frequent among women with high-grade (44/95 [46.3%]) versus low-grade smears (12/56 [21.4%]; relative risk 2.16, 95% confidence interval 1.25-3.73; P=0.004). No difference was recorded in the older age group. Although LLETZ can be performed for a CIN2 biopsy and high-grade smear, consideration should be given among young women (<30years) with low-grade smears whose biopsy histology is incidentally CIN2.

Frequency of cervical intraepithelial neoplasia grade II or worse in women with a persistent low-grade squamous intraepithelial lesion seen by Papanicolaou smears

We investigated the frequency of cervical intraepithelial neoplasia (CIN) grade II or worse in low-income Brazilian women with persistent low-grade squamous intraepithelial lesions (LSIL). A retrospective review of medical records was performed for all patients who underwent a loop electrosurgical excision procedure (LEEP) with "see and treat" strategy for persistent LSIL seen on Papanicolaou (Pap) smears (persisting >12 months in at least two consecutive tests, over a 50-month period. We assessed the colposcopy and histopathology results at the time of the procedure and at follow-up, using Pap and histopathology. Of 106 women, 48 (45.3 %) had no dysplasia by histopathology, 18 (17.0 %) had CIN I, 29 (27.4 %) had CIN II and 10 (9.4 %) had CIN III. Among the patients with CIN, 38 (66.7 %) performed the follow-up. Of these, only 4 (10.5 %) were classified as follow-up (+), all had CIN I. Women with initial CIN I had 16.7 % (n = 2) recurrences; those with initial CIN II had 5.9 % (n = 1); and those with initial CIN III had 11.1 % (n = 1) (p > 0.05). A very high proportion of the women with persistent LSIL had CIN II/III on post-LEEP histopathology. Recurrence rates were equal to than those that originally caused the patients to be subjected to LEEP (LSIL). The benefits of the "see and treat" protocol by LEEP for persistent LSIL outweigh the risk of overtreatment, principally in low-resource settings where poor patient compliance is expected, as in Brazil.

Dietary Supplements Reduce the Risk of Cervical Intraepithelial Neoplasia

To examine the effects of dietary supplements on high-risk human papillomavirus (HPV) infection and cervical carcinogenesis. A multi-institutional cross-sectional study was carried out to examine whether dietary supplements were associated with the risk of cervical intraepithelial neoplasia (CIN). We enrolled 1096 women aged 18 to 65 years to participate in an HPV cohort study from March 2006 up to present. For this analysis, we included 328 HPV-positive women (166 controls; 90 CIN I and 72 CIN II/III). The details of each participant's routine dietary intake during the prior year were collected. Specific dietary supplements were classified into 5 categories, namely, multivitamins, multinutrients, vitamin C, calcium, and miscellaneous. A higher HPV viral load was associated with an increased risk of CIN II/III (odds ratio [OR], 3.32; 95% confidence interval [CI], 1.54-7.16; P for trend 0.002). Dietary supplement use including multivitamins (OR, 0.21; 95% CI, 0.09-0.48), vitamins A (OR, 0.19; 95% CI, 0.07-0.53), C (OR, 0.24; 95% CI, 0.10-0.56), E (OR, 0.20; 95% CI, 0.07-0.53), and calcium (OR, 0.21; 95% CI, 0.08-0.50) was significantly associated with a lower risk of CIN II/III. The patients who took multivitamins and had a lower HPV viral load (<15.5 relative light units/positive control) had a significantly decreased frequency of CIN I (OR, 0.35; 95% CI, 0.14-0.87; interaction P = 0.925) and CIN II/III (OR, 0.11; 95% CI, 0.04-0.37; interaction P = 0.304). The findings of this study suggest that dietary supplements may reduce the risk of CINs in women with high-risk HPV infection.

Three-step versus “see-and-treat” approach in women with high-grade squamous intraepithelial lesions in a low-resource country

Objective To investigate the frequency of cervical intraepithelial neoplasia (CIN) 2 or greater in women with high-grade squamous intraepithelial lesion (HSIL), and to evaluate whether colposcopically-directed biopsy is a necessary procedure for managing HSIL in a low-resource country. Methods A retrospective review was undertaken of women with HSIL on a Pap smear. Results Of 348 women who had undergone colposcopically-directed biopsies and loop electrosurgical excisional procedure (LEEP), 321 (92.2%) had CIN 2 or greater. Of these, 279 were diagnosed with CIN 2 or greater on biopsy as were 264 on LEEP. The lesions in women who had CIN 2, satisfactory colposcopy, and more biopsies were more likely to be completely excised by biopsy. The mean length of time between the initial Pap smear and LEEP was significantly longer than between the initial Pap smear and biopsy. Conclusion Women with HSIL can be effectively managed using the see-and-treat approach in a low-resource country owing to the frequency of CIN 2 or greater.

Risk Factor Proportions in Israeli Patients With Cervical Intraepithelial Neoplasia 3 and Invasive Squamous Cell Carcinoma

To assess whether there is a difference in the proportion of known risk factors in Israeli women with cervical intraepithelial neoplasia (CIN) 3 compared with those with cervical squamous cell carcinoma (SCC) to explain the incidence discrepancy between the 2 entities. At admission, patients with histologically confirmed CIN 3 and SCC diagnosed between 1996 and 2006 filled out a prestructured questionnaire containing queries regarding the following variables: age, place of birth, origin (place of birth of parents), level of education, age at coitarche, number of partners, marital status, age at first pregnancy, number of pregnancies, number of children, type of contraception used, and smoking. A comparison of the proportion of these risk factors in patients with CIN 3 and SCC was performed. No statistically significant difference between 41 CIN 3 and 69 SCC patients was found with regard to any of the risk factors assessed. The discrepancy between the frequency of CIN 3 and SCC in Israeli women cannot be explained by a difference in the proportion of the known risk factors.

Is Atypical Squamous Cells That Cannot Exclude High-Grade Squamous Intraepithelial Lesion Clinically Significant?

Upwards of 50 million women in the United States are screened each year in order to identify the relatively few who have significant preinvasive cervical disease, grade 2 or 3 cervical intraepithelial neoplasia (CIN), or cancer. The Bethesda 2001 System distinguishes between atypical squamous cells of undetermined significance (ASC-US) and atypical squamous cells that cannot exclude a high-grade squamous intraepithelial lesion (ASC-H). Colposcopy is recommended for women having ASC-H. This retrospective study attempted to determine the cumulative risk of CIN 2 or 3 in patients with ASC-H. The study population consisted of 229 patients with ASC-H whose mean age was 33 years. Initial assessment included colposcopy, endocervical curettage, and ectocervical biopsy as indicated. At the time of initial colposcopy, 10% of women had histological evidence of CIN 2 or 3. More than 80% of lesions were identified by ectocervical biopsy. All affected women underwent electrosurgical loop excision. Of those women with normal initial findings, 134 had repeat colposcopy with liquid-based cytology after 6 months and 5 of them (3.7%) proved to have CIN 2 or 3. None of 59 patients who had normal findings at 6 months had histological evidence of CIN when reevaluated at 12 months. The cumulative risk of CIN 2 or 3 after 12 months was 12.2%. Using any grade of CIN as the clinical end point, the cumulative rate was 27.9%. Of those women with initially normal findings who had high-grade CIN discovered during follow-up, about 80% had low-grade squamous intraepithelial lesion or normal cytology. The frequency of CIN 2 or 3 in these women with ASC-H was lower than previously reported rates. If future studies confirm a low rate of CIN in women with ASC-H, it might be appropriate to employ other parameters in order to decide which patients require colposcopy. It might also prove helpful to combine patients having ASC-US and those with ASC-H into a single diagnostic category.

Atypical Squamous Cells of Undetermined Significance: Analysis of Microbiology, Cytological Criteria and Clinical Conduct

To differentiate between two types of atypical squamous cells of undetermined significance (ASCUS): probably neoplastic (PN) or probably reactive (PR), and, in accordance with the recommendations on screening protocols of the Emilia-Romagna Region (PSRER), Italy, to define the best management to follow and the prognosis. Furthermore, the associations between ASCUS and infectious agents and human papillomavirus (HPV) were evaluated. Fifty-eight ASCUS smears were reviewed and sorted; if a diagnosis of ASCUS was confirmed, the smear was classified as PR or PN, and the PSRER group was identified. Then, colposcopy was performed with checks for infectious agents (culture evaluation with cytological or clinical criteria) and HPV (hybrid capture). The ASCUS frequency was 3.96%. Of the 58 cases, 33 (56.9%) were diagnosed as ASCUS on review, of which 15 cases were PN and 18 were PR, while 23 (39.7%) smears were normal and 2 (3.4%) showed cervical intraepithelial neoplasia (CIN). There was a higher frequency of bacterial vaginosis (BV) and HPV in ASCUS PR patients compared with normal cytology, and a higher frequency of CIN in ASCUS PN patients compared with normal controls (P < 0.05). By grouping ASCUS 1 and 3, we observed a higher frequency of CIN and of high-grade colposcopy findings compared with ASCUS 2 and 4 (P < 0.05). From the 23 cases not found to be ASCUS, 18 (87.5%) had normal cytology and colposcopy results on the first follow-up. Classification of ASCUS as either PN or PR helps in clinical conduct and prognosis, because a higher frequency of CIN is found in ASCUS PN. ASCUS subdivisions, based on PSRER and colposcopy, may facilitate the clinical conduct because ASCUS 1 and 3 with high-grade colposcopic findings proved to be related to the presence of CIN. We propose that initial ASCUS cytology be reviewed, and if it is confirmed, colposcopy should be performed. For those cases found to be normal on review of the cytology results, it is suggested that a cytological check-up be carried out every 6 months.

Problemas ginecológicos mais freqüentes em mulheres soropositivas para o HIV

PURPOSE: to present the most frequent gynecologic results in a cohort of 300 outpatient HIV-infected women. METHODS: this is a prospective and descriptive study of HIV-infected women that have been followed up at the gynecological clinic from November 1996 to December 2002. These patients were subjected to a specific protocol which included an interview, a gynecological evaluation and a collecting cervical sample for Pap smear, research of HPV (PCR) and colposcopy. Cervical biopsy was performed when necessary. Data were stored and analyzed by Epi-Info, version 6.0. RESULTS: the mean age was 34.5 years. The small number of sexual partners, average of three partners, and the predominance of heterosexual contagion should be mentioned: 271 (90.6%) patients were contaminated through sexual contact with their partners. There was a high prevalence of cervical intraepithelial neoplasia (CIN) representing 21.7% of the total group. Of 109 patients subjected to PCR, 89 (81.7%) were found to have some HPV genotype. An inflammatory smear was present in 69% of the patients. CONCLUSIONS: there is a high frequency of CIN and genital infectious diseases among HIV-infected women, mainly HPV.

Freqüência de Neoplasia Intra-epitelial Cervical em Portadoras do Vírus da Imunodeficiência Humana

Objetivo: verificar a freqüência de neoplasia intra-epitelial cervical (NIC) em mulheres infectadas pelo vírus da imunodeficiência humana (HIV). Métodos: foram estudadas 99 mulheres HIV-soropositivas; o diagnóstico da infeccão pelo HIV foi realizado por meio de dois testes ELISA, complementados por teste Western blot ou de imunofluorescência indireta. Como grupo controle foram analisadas 104 mulheres que não apresentavam positividade no teste ELISA. Em ambos os grupos o rastreamento de NIC foi realizado por meio da associação de colpocitologia oncológica e colposcopia. Nos casos em que a colposcopia revelou existência de zonas de transformação anormal, o diagnóstico de NIC foi realizado mediante biopsia dirigida, complementada ou não por conização. Resultados: em 15 das 99 pacientes do grupo de estudo (15,2%) foi encontrada neoplasia intra-epitelial cervical, sendo dez casos de NIC I, um de NIC II e quatro de NIC III. Entre as 104 mulheres do grupo controle, quatro (3,8%) eram portadoras de neoplasia intra-epitelial cervical, encontrando-se um caso de NIC I e três de NIC III. Conclusão: a análise comparativa dos resultados evidenciou que a freqüência de neoplasia intra-epitelial cervical foi significantemente mais elevada entre as pacientes infectadas pelo HIV.

Yield of Screening Colposcopy Among Human Immunodeficiency Virus-Infected Women

Background. Among women infected with the human immunodeficiency virus, the high frequency of cervical intraepithelial neoplasia (CIN) may justify screening colpo-scopy. Methods. Screening colposcopy with cytology and biopsy were performed in 76 women enrolling in the Chicago Consortium of the Women’s Interagency Human Immunodeficiency Virus Study. Cytological smears and biopsies were read centrally. Potential risk factors for CIN were assessed. Results. Squamous intraepithelial lesion (SIL) was identified in 13% of women, and CIN1 was identified in 17%. No higher-grade CIN was found. The sensitivity of cytology in identifying CIN1 was 62%, specificity was 65%, positive predictive value was 27%, and negative predictive value was 89%. The sensitivity in SIL was 15%, the specificity was 87%, the positive predictive value was 20%, and the negative predictive value was 83%. Predictors of CIN in a multivariate model included a cytology result of atypical squamous cell of undetermined significance or worse (odds ratio versus benign smear result = 6.6; p < .04) and a history of trading sex for money or drugs (odds ratio versus no such history = 18.4; p < .02). Conclusions. In the population studied, the prevalence of CIN is low, and cytology alone appears to be adequate as a screen.

Potential hazards of following atypical and low-grade cervical cytology without colposcopy

Objective: To determine the frequency of high-grade cervical intraepithelial neoplasia in patients with atypical and low-grade cervical cytology and to assess the optimal evaluation and follow-up. Methods: Prospective observational study of 367 of 7,651 private patients who had cytologic, virologic, or colposcopic changes suggesting cervical intraepithelial neoplasia or cervical carcinoma. The study was performed to determine the frequency of cervical intraepithelial neoplasia in the various cytologic groups and to assess the effect of testing for human papillomavirus on the sensitivity, specificity, and positive predictive value of these tests. Results: Papanicolaou smears that included all non-negative tests (high- and low-grade squamous intraepithelial lesions and atypical squamous or glandular epithelial cells of undetermined significance) had the maximal sensitivity (89%) for high-grade cervical intraepithelial neoplasia and cancer. The combined cytologic categories of high- and low-grade squamous intraepithelial lesions had a sensitivity of 58%, this was reduced to 24% if only high-grade squamous intraepithelial lesions were considered relevant for additional evaluation. If we had not evaluated the patients with atypical squamous and glandular cells of undetermined significance, we would have missed diagnosing one third of high-grade and one half of low-grade cervical intraepithelial neoplasia. Cervical cytology was false negative in 8% of patients with high-grade and in 14% of those with low-grade cervical intraepithelial neoplasias. High-risk human papillomavirus deoxyribonucleic acid was detected in 40% of women with high-grade and in 24% of those with low-grade grade cervical intraepithelial neoplasias. The positive predictive value of cytology with atypical squamous cells of undetermined significance increased from 5% to 38% for high-grade and from 30 to 85% for high- and low-grade cervical intraepithelial neoplasias in patients with detectable high-risk human papillomavirus deoxyribonucleic acid. Virologic studies produced no significant improvement on these diagnoses in women with high- or low-grade cytology. Conclusions: Because of the poor sensitivity of cytology suggesting high-grade squamous intraepithelial lesions, we recommend that all women with atypical or low-grade cytology be recalled for colposcopy and high-risk human papillomavirus deoxyribonucleic acid testing, if available. Decisions whether to perform a biopsy should be based on the result of colposcopic examination. Performing colposcopy only on those patients who have cytologic high-grade squamous intraepithelial lesions and following those with lower grade cytologic anomalies without colposcopic diagnosis appears inadequate to rule out high-grade cervical intraepithelial neoplasia.

Frequency of cervical intraepithelial neoplasia following large loop excision of the transformation zone.

AIM: To determine the frequency of cervical intraepithelial neoplasia (CIN) following large loop excision of the transformation zone of the cervix (LLETZ) according to grade and completeness of excision of...

Determinants of high-grade dysplasia among women with mild dyskaryosis on cervical smear

To identify the epidemiologic characteristics of women who have mild dyskaryosis on cervical smear but cervical intraepithelial neoplasia (CIN) grade II or III at biopsy. We analyzed information from 291 women (median age 33 years, range 17-69) observed for the first time with a single smear test showing mild dyskaryosis. All subjects underwent colposcopy, and histologic confirmation was obtained by biopsy. We compared the characteristics of women who had CIN I or no evidence of CIN with those of women with CIN II or III at biopsy. Twenty-eight women (10%) had CIN I at biopsy, 46 (15%) CIN II, and 23 (8%) CIN III. The frequency of CIN II or III tended to decrease with increasing education; compared with women reporting 11 or fewer years of education, the multivariate odds ratios (OR) of CIN II or III lesions was 0.5 (95% confidence interval [CI] 0.3-0.9) in those reporting 11 years of education or more. Compared with nulliparas, the OR of CIN II or III was 1.8 (95% CI 1.1-3.5) for parous women. Furthermore, compared with never-smokers, the OR of CIN II or III was 2.3 (95% CI 1.0-5.4) for current smokers. Ex-smokers were at increased risk, too; the estimated multivariate OR was 3.8 (95% CI 1.9-7.6). Compared with women reporting one sexual partner, the multivariate ORs of CIN II or III were 1.4 and 2.3 for women reporting two to three or four or more sexual partners, respectively (chi 2(1) trend = 6.65, P < .05). Our results show that smoking is a risk indicator of CIN II or III in women with a single smear showing mild dyskaryosis. Parous women, those of low social standing, and those reporting multiple sexual partners also are at increased risk of CIN II or III.

Cervical Intraepithelial Neoplasia in Jordan: A Ten Year Retrospective Cytoepidemiologic Study

Occurrence of cervical intraepithelial neoplasia (CIN) was studied in 10,659 females attending obstetric and gynecology clinics in Jordan. The frequency rate of intraepithelial neoplasia was 1.1% in 7743 Jordanian females and 2916 non-Jordanian residents of younger age during the period from 1982 to 1991 inclusive. The incidence rate in 2649 Jordanian females, selected because they attended only for routine checkup, was 49 per 100,000. There were 121 CIN cases which were graded into Grade I (21%), II (48%) and III (31%) respectively. Histological grading correlated with cytology in 70% of the cases while in the remaining 30%, cytologic underrating by one grade was noted; evidence against any overdiagnosis of CIN in our series. Study of the human papillomavirus (HPV) was outside the scope of this effort. However, circumcision in male partners and marital status were associated with a lower frequency of CIN. Age at marriage and average duration, parity, breast feeding, the contraceptive pill, socioeconomic status and menstrual disorders showed no relationship to the frequency of CIN in our patients. Any differences in the latter between Jordanian and non-Jordanian females are believed due to cultural factors. Conization in 27 cases proved effective at 30 months' follow-up. Occurrence of CIN in Jordanian females appears substantial although much lower than that seen in high incidence zones, while its incidence in the general female population remains to be determined. This study shows for the first time the value of Papanicolaou (Pap) smears in Jordanian females over 20 years of age with special emphasis on those over 35 years of age attending obstetric and gynecology clinics.