Introduction: Human papillomavirus (HPV) is the main cause of cervical cancer. Cervical-vaginal infection with pathogens such as bacterial vaginosis, mycoplasmosis, and vaginal candidiasis may be a cofactor. This study aimed to assess the impact of co-infection with human papillomavirus and sexually transmitted infections on the development of cervical precancerous conditions in reproductive-age women. Materials and Methods: In the study, 402 women had smears taken for cytological examination and cervical scrapings taken for sexually transmitted infections (STIs). The samples were analyzed by polymerase chain reaction. Results: In the study, the incidence of STIs was 77.8%, with rates being two times lower in the HPV-positive group (33.9% versus 66.1% among HPV-negative women, p = 0.4). Notably, all women with mild and severe dysplasia had a combination of HPV and STIs. A typical combination was HPV 16, 58, and 33, often accompanied by Gardnerella vaginalis, cytomegalovirus, or Candida albicans. Conclusion: Women positive for HPV and STIs had abnormal Pap smears. Women with cervical precancerous lesions and vaginal infection were less likely to have HPV, except in high-grade squamous intraepithelial lesions. Women with high grade squamous intraepithelial lesions HPV were combined with Gardnerella, mycoplasmosis, and candidiasis.

To evaluate the performance of self and clinician collected samples for high-risk human papilloma virus (hr HPV) DNA detection and to assess the acceptance and attitude of women towards self-collection. This was a prospective single blind study done in 396 women (30-65 years) attending the gynecology outpatient department (OPD). Cervical swabs were collected in duplicate (self and clinician) in transport medium and stored at 4°C until further processing. A cervical smear was also collected at the same time. High risk HPV DNA was tested using real-time polymerase chain reaction (PCR). The samples positive for HPV DNA in any of the samples either self or clinician underwent a colposcpy guided biopsy. A total of 396 women underwent screening. A total of 8% women complained of post coital bleeding. Cervical smear was inadequate in 15% and atypical squamous cells of undetermined significance (ASCUS) and above was reported in 3.7% samples. Overall agreement between self and clinician sampled HPV (C-HPV) was 91.4% with Kappa unadjusted being 43.4% (95% CI: 35.8-51.1). Overall agreement between C-HPV and cervical smear was 79.5% with Kappa unadjusted of 19.2% (95% CI: 12.8-25.5). Overall agreement between self and cervical smear was 80.0% with Kappa unadjusted value of 21.7% (95% CI: 14.7 to 28.7). A total of 23 women underwent biopsy of which 19 were diagnosed with cervical intraepithelial neoplasia-1 (CIN-1) and above with a positive predictivity rate of 100% with either screening result being positive. HPV DNA self-sampling can be a major breakthrough in breaking the shackles of underutilization of cervical cancer screening and thus decrease the morbidity and mortality of cervical cancer.

Objective: In thyroid cytology, ancillary studies are often utilized for intermediate-category cases to better differentiate between benign and malignant lesion. For this purpose, immunocytochemical markers may be preferred because they are cheaper than molecular studies and can be applied in many laboratories. This study retrospectively compares the diagnostic accuracy of cytology samples with and without immunocytochemistry and calculates the frequency of immunocytochemical marker use, as well as sensitivity and specificity rates. Methods: Between 2015 and 2023, 1816 samples from 1506 patients with a histological diagnosis after cytological examination (thyroidectomy-lobectomy) were included. Cases without a histological diagnosis were excluded. The Thin Prep® method was used for all cytological sample preparations, and cell blocks were obtained. Demographic information, Bethesda system categories, immunocytochemical markers used, and histological diagnoses were recorded. Cases using at least one immunocytochemical marker were re-evaluated, and staining results were categorized as positive, focally positive, or negative. SPSS 15® software was used to assess data normality and perform statistical analyses. Results: The most frequently used markers were HBME-1 (n=167), CK 19 (n=106), Galectin-3 (n=75), and CD 56 (n=6). Sensitivity rates for HBME-1, CK 19, Galectin-3, and CD 56 were 91%, 94%, 76%, and 75%, respectively; specificity rates were 63%, 61%, 80%, and 50%, respectively. Comparing groups with and without immunocytochemistry, the risk of malignancy was: 6.95%-6.97% for Bethesda category II; 21.7%-19.0% for Bethesda category III; 76.0%-37.1% for Bethesda category IV; 94.0%-95.0% for category V; and 100% for category VI. Conclusion: In the follicular neoplasm group (Bethesda category IV) the risk of malignancy was higher in the immunohistochemistry applied group. No significant difference in malignancy risk was observed between groups with and without immunocytochemistry in other categories. Considering that immunocytochemical markers were predominantly applied in diagnostically challenging Bethesda categories, the similar malignancy risks across groups may suggest immunocytochemistry aids in accurate categorization. However, according to the results of this study, routine use of immunohistochemical markers in thyroid cytology is unnecessary except for Bethesda category IV.

Objective: To determine the correlation between the thyroid image and reporting data system (TIRADS) and the Bethesda system for reporting thyroid cytopathology in patients presenting with thyroid nodules. Methods: This cross-sectional study was performed at the histopathology department of Allama Iqbal teaching hospital DG Khan, over six months. A total of 87 patients aged 18 to 60 years referred to the pathology department for FNAC of thyroid nodules were included. Exclusion criteria were prior thyroid cancer diagnosis, ongoing chemo / radiotherapy or recurrence. Demographic details laterality and TIRADS grading were recorded. Samples were stained with hematoxylin and eosin and assessed microscopically. Histopathology reporting followed the Bethesda system. Data were analyzed using SPSS version 23. Spearman’s correlation was used to evaluate TIRADS and Bethesda grades. Results: The mean participant age was 36.3 ± 10.7 years. Gender distribution was almost equal. Unilateral thyroid nodules were noted in 51.7% of the cases. TIRADS grading showed most nodules as grade 3 (40.2%) or grade 4 (39.1%). FNAC reported benign cytology (grade 2) in 72.4% and malignant (grade 6) in 11.5%. Malignancy was suspected in 48.3% by TIRADS and confirmed in 22.9% on histopathology. A weak but significant positive correlation existed between TIRADS and Bethesda grade (rs = 0.245, p = 0.022). Conclusion: TIRADS showed a weak correlation to cytopathologic grading.

Introduction: Cervical cancer is one of the most prevalent cancers amongst women worldwide. Early detection and appropriate management of cervical abnormalities are essential to prevent disease progression and enable timely treatment. This study aimed to compare the diagnostic findings of colposcopy and cervical biopsy in patients with atypical squamous cells of undetermined significance (ASC-US) on Pap smear. Methods: In this descriptive-analytical cross-sectional study, patients with ASC-US Pap smear results who underwent both colposcopy and cervical biopsy between 2019 and 2023 were evaluated. Variables including age, menopausal status, HPV infection, and clinical symptoms were compared across the two diagnostic methods. Result: A total of 400 patients, with a mean age of 37.4 years, were included in the analysis. Most Pap smears were performed before menopause, and high-risk HPV was the most detected type. The most frequent clinical finding was an abnormal cervical appearance. A significant relationship was observed between the type of neoplasia and both age and menopausal status, based on colposcopy and biopsy results. Among women under 50 years of age, 52.5% showed no dysplasia; in those over 50, this rate increased to 87.5%. Cervical intraepithelial neoplasia (CIN) was the most common type of dysplasia across all age groups. Amongst premenopausal women (90.5% of the cohort), 51.6% had no dysplasia and 39.6% had CIN I. In post-menopausal women (9.5%), 97.3% had no dysplasia, with only one case of CIN I. High-risk HPV accounted for 73% of infections, amongst whom 37% showed no dysplasia. Amongst patients with an abnormal cervical appearance (48.9%), 57.1% had no dysplasia and 21.4% had CIN I. Colposcopy demonstrated a sensitivity of 73% and a specificity of 77.64%. Conclusion: In patients with ASC-US Pap smear results, colposcopic findings related to the severity of dysplasia and type of neoplasia were significantly associated with age and menopausal status. However, no significant associations were found with HPV type or clinical symptoms.

Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer in children, although its presentation in this age group remains rare. PTC, despite having a good prognosis, can present more aggressively in children than in adults. Diagnosis typically begins with physical examination and ultrasound, followed by fine-needle aspiration biopsy (FNAB) for cytological assessment using the Bethesda system. Standard treatment for PTC is surgery — lobectomy or total thyroidectomy depending on disease spread, cytological findings, and patient profile. This paper presents the clinical case of a 9-year-old female patient with a suspicious thyroid nodule, successfully treated through thyroid lobectomy. Ultrasound revealed a solid, hypoechoic nodule with microcalcifications in the right thyroid lobe. FNAB returned a Bethesda V classification, raising suspicion for papillary carcinoma. After a multidisciplinary evaluation by the medical team (endocrinologist, surgeon, cytopathologist, radiologist, pediatric oncologist), a right thyroid lobectomy was decided upon for both diagnostic and therapeutic purposes. During surgery, a well-confined nodule was identified with no apparent invasion into surrounding tissues. Histopathological analysis confirmed papillary thyroid carcinoma, follicular variant, no vascular or extrathyroidal invasion, no metastases in the examined lymph nodes. These findings suggested a localized disease form with an excellent prognosis. Following the intervention, the patient recovered without complications: vital parameters remained stable, with no signs of bleeding or local infection; follow-up ultrasound at 6 weeks showed no residual formations, and normal structure of the left lobe and surrounding tissues. There was no need for total thyroidectomy or radioactive iodine therapy, in accordance with current protocols for localized cases. The importance of early diagnosis, appropriate surgical treatment, and careful clinical follow-up is discussed, as well as the role of a multidisciplinary team in managing pediatric endocrine oncology cases.

Previous studies showed the association between sexually transmitted infections (STIs) and cervical lesions remains ambiguous. This study was conducted among 8371 women from a screening cohort. Seven specific sexually transmitted pathogens (STPs), including one viral [high-risk human papillomavirus (hrHPV), low-risk HPV (lrHPV)], five bacterial [Ureaplasma parvum (UP), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), and Mycoplasma genitalium (MG)], and one parasitic [Trichomonas vaginalis (TV)] pathogen, were tested by Next Generation Sequencing assay using well-stored baseline samples. Odds ratios (ORs) for incident cervical lesions with different STPs were calculated by Logistic Regression analysis. Within 3-year follow-up, 133 and 72 participants were diagnosed with histopathological cervical intraepithelial neoplasia grade 1 (CIN1) and CIN2+, respectively. The adjusted ORs (aORs) of atypical squamous cells of undetermined significance or worse (ASC-US+) for women with hrHPV, lrHPV, UP, MH, TV, CT, and MG infections were 2.62 (95% CI: 2.19-3.13), 1.94 (95% CI: 1.55-2.43), 1.48 (95% CI: 1.26-1.74), 1.47 (95% CI: 1.25-1.73), 1.65 (95% CI: 1.27-2.15), 1.26 (95% CI: 0.79-2.01) and 2.33 (95% CI: 1.41-3.85), respectively. The aORs of cytological high-grade squamous intraepithelial lesions (HSIL) for women with hrHPV, TV, and MG infections were 13.01 (95% CI: 5.78-29.31), 3.48 (95% CI: 1.38-8.75), and 5.87 (95% CI: 1.58-21.77). The aORs of CIN1 for hrHPV, lrHPV, and MH were 6.88(95% CI: 4.79-9.90), 2.04(95% CI: 1.29-3.14), and 1.47(95% CI: 1.02-2.11). The aOR of CIN2+ for women with hrHPV infection was 17.56 (95% CI: 10.31-29.92), no significance was observed for CIN2+ with non-hrHPV STIs. Specific STP infections were significantly associated with subsequent cervical cytological ASC-US+ (hrHPV, lrHPV, UP, MH, TV, and MG) and HSIL (hrHPV, TV, and MG). Infection with lrHPV and MH could increase the CIN1 risk in future though no obvious CIN2+ risk elevation was observed.

BackgroundSexually transmitted infections (STI) are a prominent health issue in Africa, especially in key populations such as men who have sex with men (MSM). Here, we present the baseline results of a 2-year longitudinal cohort in Togo.MethodsA total of 200 MSM in Lomé, Togo, were included in the ANRS I MIE 12400/DepIST-H cohort, half living with HIV. High-risk HPV (hrHPV) detection was performed on anal smears. Neisseria gonorrhoeae (GC) and Chlamydia trachomatis (CT) were tested from urine, pharyngeal and anal swabs.ResultsOverall, median age was 23 years, hrHPV prevalence was 75.9%, and was significantly higher in HIV-positive MSM (p = 0.008). The most common hrHPV types were HPV16 and HPV35 (18.7% each). Overall, 55.4% of participants had abnormal anal cytology, the most frequent lesions being low-grade squamous intraepithelial lesions, (22.3% of HIV-positive and 15.2% of HIV-negative MSM). The overall prevalence of GC and CT infections was 32.5% and 32.0%, respectively. Clinical anal lesions, mostly condyloma, were detected in 46.0% of participants (n = 86).ConclusionsThese findings emphasize the high prevalence of STIs among MSM and confirm the unusual distribution of HPV types in West Africa, with HPV35 being highly prevalent. A national strategy regarding STI screening and HPV vaccination in this key population is needed.Trial registrationNCT04910438 submitted on 2020-01-22.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-025-11338-y.

ObjectiveTo study and predict the risk of further vaginal lesions after surgery in patients with HPV-associated cervical cancer.MethodsMedical records of women who underwent surgery for cervical cancer between January 2018 and December 2022 at the Obstetrics and Gynecology Hospital of Fudan University were analyzed. Incidence and genotype of persistent HPV infection were recorded and patients with further vaginal lesions were analyzed for clinicopathological risk factors. Of the patients, 70% were randomly grouped into a training cohort, and predictive prognostic models for vaginal lesions were constructed through machine learning. The model with the highest area under the receiver operator curve (AUC) was screened out in the testing cohort. The nomogram and its calibration curve presented the risk of sequela vaginal lesions. R 4.2.0 software was used for all data processing.ResultsWithin five years after surgery, 29.94% of patients remained persistently infected with HPV, with annual rates fluctuating around 22%. In addition, 10.2% of patients were diagnosed with vaginal intraepithelial neoplasia (VaIN), and 320 cases (78.35%) were low-grade squamous intraepithelial lesions (LSIL). The annual incidence of vaginal lesions decreased gradually from 6.97% in the first year (Y1) to 2.96% at year 5 (Y5). Ovarian preservation (OP) during hysterectomy and adenocarcinoma histology were found to be protective from further vaginal lesions, while elder age, FIGO stage II, and positive vaginal incision margin were significant risk factors. As for persistent HPV infection, both single and multiple genotype remarkably increased the risk of vaginal lesions, and a α-9 HPV infection (OR = 18.20) brought higher risk than non-α-9 HPV (OR = 11.76). Then we built three predictive models; multiple logistic regression was optional, with its AUC at 0.7955 in the ROC curve.ConclusionThe predictive model constructed in our study could identify populations at high risk of vaginal lesions and precisely guide clinical interventions.

Human papillomavirus (HPV) infection presents neoplastic risks in both cervix and anus. High-resolution colposcopy/anoscopy is crucial for assessing these regions but has suboptimal accuracy. This study aims to develop a Convolutional Neural Network (CNN) to identify and differentiate low-grade (LSIL) and high grade (HSIL) squamous intraepithelial lesions, in the cervix and anus. A retrospective multicenter study was conducted to develop a CNN using 320 colposcopy and anoscopy examinations, from 3 device types. Dataset included 88,073 frames, categorized as LSIL or HSIL based on pathological analysis. The data was split into training/validation (90%, n = 79,265, including a threefold cross-validation) and test sets (10%, n = 8808). Diagnostic metrics including sensitivity, specificity, accuracy, positive and negative predictive values (PPV and NPV, respectively) and an area under the receiving operating and the precision-recall curves (AUC-ROC and AUC-PR) were calculated. During training/validation phase, the model achieved an average sensitivity for HSIL of 98.1% (IC95% 97.6–98.5%), specificity of 97.4% (IC95% 96.0–98.8%), PPV of 97.2% (IC95% 95.8–98.7%), NPV of 98.2% (IC95% 97.7–98.6%), and accuracy of 97.7% (IC95% 97.2–98.6%). The mean AUC-ROC and AUC-PR were both 0.98 ± 0.01. In the testing phase, performance metrics for HSIL were: sensitivity 99.0%, specificity 97.8%, PPV 97.6%, NPV 99.0%, and accuracy 98.3%. HPV infection impacts both cervical and anal region. This study developed a pioneering CNN to differentiate HSIL and LSIL in HPV-related dysplastic lesions, during cervical and anal examinations. This model achieved promising results, suggesting its potential to improve detection accuracy and cost-effectiveness in clinical practice.

This cross-sectional observational study involved 1052 non-pregnant women aged 18–65 who had undergone TCC and sought care at a tertiary-level gynecology clinic. We documented participants’ medical histories, Pap smear results, and TCC histories. Pap smear results were analyzed using the 2014 Bethesda classification, and obstetric outcomes, including pregnancies, deliveries, miscarriages, and preterm births (PTD), were evaluated. Data analysis was performed using SPSS 22.0, with statistical significance set at p < 0.05. This cross-sectional observational study involved 1052 non-pregnant women aged 18–65 who had undergone TCC and sought care at a tertiary-level gynecology clinic. We documented participants’ medical histories, Pap smear results, and TCC histories. Pap smear results were analyzed using the 2014 Bethesda classification, and obstetric outcomes, including pregnancies, deliveries, miscarriages, and preterm births (PTD), were evaluated. Data analysis was performed using SPSS 22.0, with statistical significance set at p < 0.05. The mean age of participants was 34.4 ± 7.4 years. Abnormal Pap smear results were observed in 11.5% of patients, with a higher prevalence (29.9%) among those who underwent TCC within the last year. The frequency of TCC was inversely related to the rate of abnormal smear results (p < 0.005). However, frequent TCC procedures were associated with significantly increased rates of abortion (18.9%) and PTD (10.3%) (both p < 0.005). While the time elapsed since the last TCC procedure influenced abortion and PTD rates, both were statistically significant (p = 0.016 and p = 0.029, respectively). TCC is associated with a higher incidence of cervical abnormalities and adverse pregnancy outcomes, particularly when performed more frequently. These findings suggest a potential link between TCC and disruptions in cervical health, which may increase the risk of pregnancy complications, underscoring the need for cautious use and further research. Educating communities about the potential risks and advocating for safer medical practices are crucial steps towards improving gynecological and obstetric care in regions where TCC is still prevalent.

Introduction: The rate of malignancy (ROM) among pediatric studies using the Bethesda System is 39.5% and 41.5% for atypia of undetermined significance/follicular lesion of undetermined significance and for suspected follicular neoplasm, respectively. Data reported on the basis of Bethesda System showed lower ROM in adults with indeterminate nodules (30.5% and 28.9%, respectively). Studies on adults based on the Italian Society of Anatomic Pathology and Cytology (SIAPEC) classification, report a ROM of 4–20.8% for TIR3a and 28–60.3% for TIR3b category, showing greater sensitivity in detecting malignancy. To date, very few performance data are available about SIAPEC classification in pediatric age. Methods: Multicentre retrospective data were collected from 44 pediatric subjects with thyroid nodules. Results: The distribution of cytological categories after fine-needle aspiration biopsy (FNAB) was 26 TIR3a and 18 TIR3b. Surgical approach was performed in 8/26 subjects with TIR3a and 18/18 subjects with TIR3b with a total ROM of 53.8% (12.5% for TIR3a, 72.8% for TIR3b). Total FNAB accuracy for the indeterminate cytologic category was 77%. Conclusion: The reported data seem to confirm a greater sensitivity of SIAPEC classification to identify malignancy within the indeterminate category also in pediatric age and not only in adulthood. This finding may orient clinicians toward clinical follow-up for the indeterminate TIR3a group and toward surgical approach with total thyroidectomy in the indeterminate TIR3b group, although this indication should be confirmed in further national multicenter studies including larger cohorts.

Higher levels of host-cell DNA methylation markers ZNF582 and ASCL1 on anal smears are predictive for progression to anal cancer in patients with previous high-grade lesions

Impact of thyroid Bethesda category IV (follicular neoplasm) terminology unification on atypia of undetermined significance reporting patterns in thyroid fine-needle aspiration.

IntroductionThe vulvar microbiome is adjacent to that of the skin and the vagina and connects microbiomes present on a stratified epithelial barrier to that of a mucosal barrier. Yet, the characterization of the microbiome in the vulvar region of the body is understudied, although dysbiosis in the microbiome of the skin or vagina have been linked to impairments in women’s health.MethodsTo better understand the role of the vulvar microbiome during healthy aging or during presentation of vulvar diseases, we analyzed the vulvar microbiome by shotgun metagenomic sequencing on composition at species level and for functional capacity. This was performed in a large population enrolled in the Vulvar Microbiome Leiden Cohort (VMLC), including a total of 58 healthy women in a broad age range (22–82 years). Moreover, we analyzed vulvar microbiome derived from 9 participants presenting a vulvar disease, including vulvar lichen sclerosus (LS; N = 6), or high-grade squamous intraepithelial lesion (HSIL; N = 3).ResultsCompositional analyses showed a skin-, vagina-, or multispecies mixture- dominant bacterial signature, which revealed differences in the alpha diversity and functional capacity of the microbiome. Upon aging the presence of Lactobacillus iners, L. crispatus, and L. gasseri in the vulvar microbiome shifted toward reduction. In the microbiome of individuals with a vulvar disease, higher abundance of Staphylococcus hominis, Micrococcus luteus, Corynebacterium amycolatum, and Corynebacterium simulans was detected, and an altered functional capacity for the L-histidine pathway.DiscussionIn conclusion, we identified variations in microbial taxa and functional capacities in the vulvar microbiome that are associated with age and disease (LS and HSIL), which can be targeted to develop microbiome-based vulvar therapies promoting women’s health.

ABSTRACTObjectiveThe 2023 Bethesda System update introduced molecular testing as a management option for Bethesda V cytology nodules, aiming to guide surgical decision‐making. This study investigates the correlation between molecular profiling and malignancy aggressiveness.DesignWe conducted a retrospective multicenter study involving patients with Bethesda V cytology and confirmed malignant pathology who underwent molecular profiling between 2018 and 2021.PatientsA total of 156 patients with Bethesda V cytology and final malignant histology were included.MeasurementsMalignancy aggressiveness was assessed based on histopathological features following 2015 ATA guidelines. Demographic data, pathology results, and genetic variants were analyzed. Molecular profiling results were stratified according to variant risk levels.ResultsWe identified 161 Bethesda V nodules, of which 153 (95.0%) were malignant on final pathology. Genetic stratification revealed no detected mutations in 39.7% (n = 56), low‐risk (n = 49, 31.4%), and intermediate‐risk variants (n = 45, 28.8%). Only one patient had a high‐risk variant. Patients with intermediate‐risk variants had a sixfold risk of aggressive disease compared to those with low‐risk variants (49% vs. 8.2%, p < 0.001). RAS mutations were the most common among the low‐risk group (68.8%) and BRAF V600E predominated in the intermediate‐risk group (93.3%).ConclusionsOur findings suggest that molecular profiling offers insights into risk stratification for Bethesda V thyroid lesions, demonstrating a very low incidence of aggressive pathology in the low‐risk molecular group.

EBM BLS: Treating Anal High-grade Squamous Intraepithelial Lesions Reduces Progression to Invasive Anal Cancer in People Living with HIV.

ObjectiveThis study explored the prognosis of high-grade squamous intraepithelial lesion (HSIL) patients with negative margins, investigating the impact of different distances between lesions and incisal margins in conization specimens.MethodsThis retrospective cohort study included 240 HSIL patients. Patients with negative incisal margins were divided into 3 groups according to the distance between the lesion and the incisal margin in the conization tissue. Group 1 consisted of a distance of <1 mm (n = 23), Group 2 of 1–3 mm (n = 15), and Group 3 of >3 mm (n = 202). For patients with lesions close to the incisal margin (≤3 cm), the decision between total hysterectomy and clinical observation was made based on patient preference following detailed counseling of disease characteristics and prognosis. Thinprep cytologic test (TCT) and HPV testing were performed during follow-up at 6 and 12 months after the operation.ResultsNo significant difference in HPV and TCT positive rate was observed among the three groups at 6 months and 12 months after the operation (P = 0.561, 0.561 and P = 0.324, 0.268). In the group with a distance shorter than 3 mm, no difference in HPV positive rate was found between the total hysterectomy and observation groups (P = 0.480, 0.737). Additionally, no difference in HPV positive rate was observed between patients who underwent total hysterectomy compared to clinical observation in groups 1 and 2 (P = 0.565, 0.692; P = 0.758, 0.593). Stratified analysis revealed that HPV positive rates at 6 months and 12 months had no statistical significance with any factor.ConclusionDifferent distances between conization tissue lesions and incisal edges have no direct impact on the prognosis of HSIL patients with negative conization biopsy tissues; excessive hysterectomy is not recommended in patients (≤3 mm) close to incisal edges.

Background:Treatment protocol for patients with cervical histologic low-grade squamous intraepithelial lesion (LSIL) such as that preceded by serious cytology and repeated diagnosis for at least 2 years is unclear.Objective:This study investigates the follow-up results of patients with cervical histologic LSIL and aims to provide evidence support for treatment and follow-up strategy.Design:A retrospective observational study design was used.Methods:The retrospective study included 4263 patients with cervical histologic LSIL diagnosed between August 2014 and February 2021. The follow-up period ended in August 2023.Results:During the followed-up of 6–101 months, 3246 (76.1%), 628 (14.7%), and 389 (9.1%) of the 4263 patients had lesion regression, persistence, and progression. Multiple gravidities, high-risk human papillomavirus (HPV) positive, HPV 16 positive, and cytologic examination (⩾atypical squamous cells cannot exclude high grade squamous intraepithelial lesion (ASC-H)) were independent risk factors for histologic LSIL progression. The annual cumulative cervical intraepithelial neoplasia (CIN)3+ rate of patients with histologic LSIL preceded by cytologic ASC-H and gravidity >2 was 6.3% (1-year), 22.4% (2-year), 28.2% (3-year), 28.2% (4-year), and 28.2% (5-year). The cumulative CIN2+ and CIN3+ rates in patients with histologic LSIL under risk factors and repeated diagnosis for at least 2 years were significantly higher than patients preceded by cytologic negative for intraepithelial lesion or malignancy, atypical squamous cells of undetermined significance, and LSIL.Conclusion:Cervical histologic LSIL had a high natural regression rate and a low progression rate. Multiple gravidities, high-risk HPV positivity, HPV 16 positivity, and cytological examination ⩾ASC-H were risk factors for histologic LSIL progression. For patients with histologic LSIL preceded by cytologic ASC-H, stratified management based on the number of gravidities might be an option.

Objective:This study aimed to assess the prevalence of cervical High-Grade Squamous Intraepithelial Lesions (HSIL) in women outside the screening age recommended by the Brazilian Guidelines for Cervical Cancer Screening (under 25 and over 64 years old).Methods:The cross-sectional study was conducted at a reference hospital in Rio de Janeiro with a histopathological report of CIN 2 + from January 2010 to December 2020 through the analysis of medical records.Results:Among 406 women diagnosed with Cervical Intraepithelial Neoplasia (CIN) 2+, 63 patients (15.5%) were outside the recommended screening age, 17(4.2%) of whom were under the age of 25, and 46 (11.3%) were older than 64 years. CIN 2 was most prevalent in women under 25 years old (29.4%); CIN 3 in those between 25 and 64 years old (55.1%); and invasive cancer predominated in women over 64 years old, with statistical significance (<0.001).Conclusion:The higher frequency of CIN 2 in young women under 25 years old supports the transient nature of these lesions, reinforcing that screening this age group may lead to unnecessary treatment. Conversely, the detection of high-grade lesions and cancer in older women is a consequence of inadequate screening earlier in life.