Colposcopic Impression Has a Key Role in the Estimation of the Risk of HSIL/CIN3

Abstract

Recently published guidelines stratify the risk of high-grade squamous intraepithelial lesion/grade 3 cervical intraepithelial neoplasia (HSIL/CIN3) based on hrHPV detection and Pap smear results. However, colposcopic impression could also provide valuable information for risk estimation. We aimed to analyze the value of adding colposcopic impression to screening tests for the diagnosis of HSIL/CIN3 in 302 women referred for colposcopy due to an abnormal Pap smear. All women underwent hrHPV detection and genotyping (HPV 16/18 vs. non-16/18 hrHPV), Pap smear, and colposcopy with at least one biopsy. HSIL Pap smear, HPV 16/18, and grade 2 colposcopy findings increased the risk of HSIL/CIN3 in the univariate analysis but only colposcopy retained significance in the multivariate model. At least 30% of the women with grade 2 colposcopy findings had HSIL/CIN3, independent of the screening test results. Among women with an HSIL Pap smear and grade 2 colposcopy findings, 53.3% had HSIL/CIN3 independently of the hrHPV genotype. Contrarily, the prevalence of HSIL/CIN3 in women with <HSIL Pap smear, non-HPV 16/18 infection, and normal colposcopy or with grade 1 findings was 2.9% and 8.1%, respectively. In conclusion, colposcopy impression provides essential information to identify women at risk of HSIL/CIN3.

Keywords: HSIL/CIN3; colposcopy; risk-based management.

Figure 1

Prevalence of HSIL/CIN2+ (black diamonds) and HSIL/CIN3 (red triangles) according to the Pap test result, hrHPV testing, and colposcopic impression including the 231 women in whom the presence or absence of grade 2 colposcopy lesions could be confidently excluded or confirmed (all women with a type 1 or 2 transformation zone and women with a type 3 transformation zone with grade 2 findings). No women showed a negative Pap-test with HPV 16/18 infection or grade 1 or grade 2 findings in the colposcopy evaluation. Footnote: (−): negative; LSIL: low-grade squamous intraepithelial neoplasia (including atypical squamous cell of undetermined significance (ASC-US)); HSIL: high-grade squamous intraepithelial neoplasia; hrHPV: high-risk human papillomavirus; HSIL/CIN2+: high-grade squamous intraepithelial lesion/grade 2 or 3 cervical intraepithelial neoplasia or adenocarcinoma in situ. HSIL/CIN3: high-grade squamous intraepithelial lesion/grade 3 cervical intraepithelial neoplasia or adenocarcinoma in situ. N: normal colposcopy; g1: grade 1 findings; g2: grade 2 findings.

Figure 2

Prevalence of HSIL/CIN2+ (black diamonds) and HSIL/CIN3 (red triangles) according to the Pap test result, hrHPV testing and genotyping, and colposcopic impression considering the 231 women in whom the presence or absence of grade 2 colposcopy lesions could be confidently excluded or confirmed (all women with a type 1 or 2 transformation zone and women with a type 3 transformation zone with grade 2 findings). No women showed a negative Pap test with HPV 16/18 infection or grade 2 findings at the colposcopy evaluation. Footnote: (−): negative; LSIL: low-grade squamous intraepithelial neoplasia (including atypical squamous cell of undetermined significance (ASC-US)); HSIL: high-grade squamous intraepithelial neoplasia; hrHPV: high-risk human papillomavirus; HSIL/CIN2+: high-grade squamous intraepithelial lesion/grade 2 or 3 cervical intraepithelial neoplasia or adenocarcinoma in situ. HSIL/CIN3: high-grade squamous intraepithelial lesion/grade 3 cervical intraepithelial neoplasia or adenocarcinoma in situ. N: normal colposcopy; g1: grade 1 findings; g2: grade 2 findings.