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Subsequent risks for cervical precancer and cancer in women with low-grade squamous intraepithelial lesions unconfirmed by colposcopy-directed biopsy: results from a multicenter, prospective, cohort study |
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| Authors: | Koji Matsumoto Yasuo Hirai Reiko Furuta Naoyoshi Takatsuka Akinori Oki Toshiharu Yasugi Hiroo Maeda Akira Mitsuhashi Takuma Fujii Kei Kawana Tsuyoshi Iwasaka Nobuo Yaegashi Yoh Watanabe Yutaka Nagai Tomoyuki Kitagawa Hiroyuki Yoshikawa |
| Institution: | 1. Department of Obstetrics and Gynecology, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8575, Japan 2. Departments of Gynecology and Cytopathology, Cancer Institute Hospital, Japanese Foundation of Cancer Research, Tokyo, 135-8550, Japan 3. Department of Pathology, Cancer Institute, Japanese Foundation of Cancer Research, Tokyo, 135-8550, Japan 4. Department of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, Gifu, 501-1194, Japan 5. Department of Obstetrics and Gynecology, University of Tokyo, Tokyo, 113-8655, Japan 6. Department of Transfusion Medicine and Cell Therapy, Saitama Medical Center, Saitama Medical University, Saitama, 350-8550, Japan 7. Department of Reproductive Medicine, Graduate School of Medicine, Chiba University, Chiba, 260-8670, Japan 8. Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, 160-8582, Japan 9. Department of Obstetrics and Gynecology, Faculty of Medicine, Saga University, Saga, 849-8501, Japan 10. Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Sendai, 980-8574, Japan 11. Department of Obstetrics and Gynecology, Kinki University School of Medicine, Osaka, 589-8511, Japan 12. Department of Obstetrics and Gynecology, Faculty of Medicine, University of the Ryukyus, Okinawa, 903-0215, Japan |
| Abstract: | ObjectiveTo investigate the natural course of low-grade squamous intraepithelial lesions (LSILs) that cannot be histologically confirmed by colposcopy-directed biopsy.MethodsIn a multicenter, prospective, cohort study of Japanese women with LSILs, we analyzed the follow-up data from 64 women who had a negative biopsy result at the initial colposcopy (biopsy-negative LSIL) in comparison with those from 479 women who had a histologic diagnosis of cervical intraepithelial neoplasia grade 1 (LSIL/CIN1). Patients were monitored by cytology and colposcopy every 4?months for a mean follow-up period of 39.0?months, with cytologic regression defined as two consecutive negative smears and normal colposcopy.ResultsIn women with biopsy-negative LSILs, there were no cases of CIN3 or worse (CIN3+) diagnosed within 2?years; the difference in the 2-year risk of CIN3+?between the two groups was marginally significant (0 vs. 5.5%; P?=?0.07). The cumulative probability of cytologic regression within 12?months was much higher in the biopsy-negative LSIL group (71.2 vs. 48.6%; P?=?0.0001). The percentage of women positive for high-risk human papillomaviruses (hrHPVs) was significantly lower in the biopsy-negative LSIL group than in the LSIL/CIN1 group (62.1 vs. 78.4%; P?=?0.01); however, the 12-month regression rate of biopsy-negative LSIL was similar between hrHPV-positive and -negative women (67.3 vs. 74.4%, P?=?0.73).ConclusionIn women with biopsy-negative LSILs, the risk of CIN3+?diagnosed within 2?years was low; furthermore, approximately 70% underwent cytologic regression within 12?months, regardless of HPV testing results. Biopsy-negative LSILs may represent regressing lesions rather than lesions missed by colposcopy. |
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