Colposcopic Impression Has a Key Role in the Estimation of the Risk of HSIL/CIN3
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Protocol and Patient Selection
2.2. Colposcopy and Biopsy Sampling
2.3. Liquid-Based Cytology and hrHPV Testing
2.4. Histological Diagnosis
2.5. Statistical Analysis
3. Results
3.1. Pap Smear, hrHPV Testing, Colposcopic Impression, and Final Diagnosis
3.2. Correlation between the Combined Results of the Tests (Pap Smear, hrHPV Testing, and Colposcopy) and the Final Diagnosis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patients Characteristics | n | (%) |
---|---|---|
Age (mean) | 37.6 | ±10.3 |
Immunosuppression | ||
No | 296 | (98.0%) |
Yes | 6 | (2.0%) |
Smoking habits | ||
No | 151 | (50.0%) |
Current smoker | 40 | (13.2%) |
Yes* | 111 | (36.8%) |
*Cigarettes per day | ||
<10 | 58 | (52.3%) |
10–20 | 43 | (38.7%) |
>20 | 10 | (9.0%) |
Referral Pap smear | ||
ASC-US | 53 | (17.5%) |
LSIL | 120 | (39.8%) |
HSIL | 129 | (42.7%) |
Referral Pap Smear | Pap Smear Result of the First Visit | |||||||
---|---|---|---|---|---|---|---|---|
Negative | ASC-US | LSIL | HSIL | |||||
ASC-US | 10 | (18.9) | 7 | (13.2) | 25 | (47.2) | 11 | (20.7) |
LSIL | 7 | (5.8) | 11 | (9.2) | 77 | (64.2) | 25 | (20.8) |
HSIL | 6 | (4.6) | 6 | (4.6) | 37 | (28.7) | 80 | (62.1) |
First Visit Tests Results | Final Histological Diagnosis | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
n | Negative (n = 128) | LSIL/CIN1 (n = 51) | HSIL/CIN2 (n = 42) | HSIL/CIN3 (n = 81) | p | |||||
Pap smear result of first visit | ||||||||||
Negative | 23 | 13 | (56.6) | 3 | (13.0) | 4 | (17.4) | 3 | (13.0) | <0.001 |
ASC-US | 24 | 14 | (58.4) | 5 | (20.8) | 3 | (12.5) | 2 | (8.3) | |
LSIL | 139 | 76 | (54.7) | 29 | (20.8) | 9 | (6.5) | 25 | (18.0) | |
HSIL | 116 | 25 | (21.5) | 14 | (12.1) | 26 | (22.4) | 51 | (44.0) | |
hrHPV result | ||||||||||
Negative | 68 | 48 | (70.6) | 7 | (10.3) | 3 | (4.4) | 10 | (14.7) | <0.001 |
Non-16/18 hrHPV | 108 | 44 | (40.7) | 19 | (17.6) | 16 | (14.8) | 29 | (26.9) | |
HPV 16/18 | 126 | 36 | (28.6) | 25 | (19.8) | 23 | (18.3) | 42 | (33.3) | |
Colposcopic impression | ||||||||||
Normal | 116 | 76 | (65.5) | 15 | (12.9) | 12 | (10.4) | 13 | (11.2) | <0.001 |
Grade 1 findings | 88 | 35 | (39.7) | 24 | (27.3) | 10 | (11.4) | 19 | (21.6) | |
Grade 2 findings | 98 | 17 | (17.4) | 12 | (12.2) | 20 | (20.4) | 49 | (50.0) |
Risk Factors | HSIL/CIN3 | HSIL/CIN2+ | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Univariate Analysis | Multivariate Analysis | Univariate Analysis | Multivariate Analysis | |||||||||
OR | (95% CI) | p | OR | (95% CI) | p | OR | (95% CI) | p | OR | (95% CI) | p | |
Age | ||||||||||||
≤35 years | 1 | 1 | ||||||||||
>35 years | 0.9 | (0.6–1.5) | 0.773 | NA | 1.1 | (0.7–1.7) | 0.804 | NA | ||||
Pap smear of the first visit | ||||||||||||
Negative | 1 | 1 | 1 | 1 | ||||||||
LSIL | 1.3 | (0.4–4.8) | 0.668 | NA | 0.7 | (0.3–1.9) | 0.500 | NA | ||||
HSIL | 5.2 | (1.5–18.6) | 0.011 | 2.0 | (1.2–3.5) | 0.011 | 4.5 | (1.7–11.9) | 0.002 | 2.7 | (0.9–7.9) | 0.064 |
hrHPV genotyping | ||||||||||||
Negative | 1 | 1 | 1 | 1 | ||||||||
Non-16/18 hrHPV | 2.1 | (0.9–4.7) | 0.062 | 1.7 | (0.7–4.0) | 0.208 | 3.0 | (1.5–6.2) | 0.002 | 2.4 | (1.1–5.3) | 0.036 |
HPV 16/18 | 2.9 | (1.3–6.2) | 0.006 | 2.0 | (0.9–4.8) | 0.099 | 4.5 | (2.2–9.1) | <0.001 | 2.7 | (1.2–6.1) | 0.015 |
Colposcopic impression | ||||||||||||
Normal | 1 | 1 | 1 | 1 | ||||||||
Grade 1 findings | 2.2 | (1.0–4.7) | 0.047 | 2.0 | (0.9–4.5) | 0.074 | 1.8 | (1.0–3.3) | 0.069 | 1.8 | (0.9–3.4) | 0.098 |
Grade 2 findings | 7.9 | (3.9–15.9) | <0.001 | 5.4 | (2.6–11.5) | <0.001 | 9.0 | (4.8–16.7) | <0.001 | 5.5 | (2.8–10.9) | <0.001 |
Test Result | HSIL/CIN2+ | HSIL/CIN3 | ||||||
---|---|---|---|---|---|---|---|---|
Sensitivity | (95% CI) | Specificity | (95% CI) | Sensitivity | (95% CI) | Specificity | (95% CI) | |
Single test results | ||||||||
HSIL Pap | 62.6 | (53.8–70.6) | 78.2 | (71.6–83.6) | 63.0 | (44.2–78.5) | 70.6 | (64.3–83.6) |
HPV 16/18 | 52.8 | (44.1–61.4) | 65.9 | (58.7–72.5) | 63.0 | (52.1–72.7) | 70.6 | (64.3–76.2) |
Grade 2 findings | 56.1 | (47.3–64.5) | 84.3 | (78.2–88.9) | 60.5 | (49.6–70.4) | 77.8 | (71.9–82.8) |
Combination of two tests | ||||||||
HSIL Pap + HPV 16/18 | 39.8 | (31.6–48.7) | 86.6 | (80.8–90.8) | 38.3 | (28.4–49.2) | 81.0 | (75.3–85.2) |
HSIL Pap + grade 2 findings | 41.8 | (33.4–50.7) | 91.1 | (86.0–94.4) | 43.2 | (33.0–54.1) | 85.1 | (79.8–89.2) |
HPV 16/18 + grade 2 findings | 33.3 | (25.6–42.1) | 93.3 | (88.6–96.1) | 34.6 | (25.1–45.4) | 88.7 | (83.8–92.1) |
Combination of the three tests | ||||||||
HSIL Pap + HPV 16/18 + grade 2 findings | 29.3 | (21.9–37.8) | 95.0 | (90.7–97.3) | 30.8 | (21.6–41.7) | 90.5 | (85.9–93.7) |
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del Pino, M.; Angeles, M.A.; Martí, C.; Henere, C.; Munmany, M.; Marimon, L.; Saco, A.; Rakislova, N.; Ordi, J.; Torné, A. Colposcopic Impression Has a Key Role in the Estimation of the Risk of HSIL/CIN3. Cancers 2021, 13, 1224. https://doi.org/10.3390/cancers13061224
del Pino M, Angeles MA, Martí C, Henere C, Munmany M, Marimon L, Saco A, Rakislova N, Ordi J, Torné A. Colposcopic Impression Has a Key Role in the Estimation of the Risk of HSIL/CIN3. Cancers. 2021; 13(6):1224. https://doi.org/10.3390/cancers13061224
Chicago/Turabian Styledel Pino, Marta, Martina Aida Angeles, Cristina Martí, Carla Henere, Meritxell Munmany, Lorena Marimon, Adela Saco, Natalia Rakislova, Jaume Ordi, and Aureli Torné. 2021. "Colposcopic Impression Has a Key Role in the Estimation of the Risk of HSIL/CIN3" Cancers 13, no. 6: 1224. https://doi.org/10.3390/cancers13061224
APA Styledel Pino, M., Angeles, M. A., Martí, C., Henere, C., Munmany, M., Marimon, L., Saco, A., Rakislova, N., Ordi, J., & Torné, A. (2021). Colposcopic Impression Has a Key Role in the Estimation of the Risk of HSIL/CIN3. Cancers, 13(6), 1224. https://doi.org/10.3390/cancers13061224