Abstract
Objective
To determine the baseline and cumulative risks of cervical intraepithelial lesion
grade 3 (CIN3) and invasive cervical cancer in patients with <CIN2 colposcopy findings
after a low-grade screening cytology finding (atypical squamous cells of undetermined
significance or low-grade squamous intraepithelial lesion [LSIL]).
Methods
By linking administrative databases, including cytology, pathology, cancer registries,
and physician billing history, a population-based cohort study was performed on participants
with <CIN2 initial colposcopy results after a low-grade antecedent cytology finding,
between January 2012 and December 2013. Three and 5-year risks of CIN3 and invasive
cervical cancer were generated using Kaplan-Meier survival analysis.
Results
Among the 36 887 participants included in the study, CIN3 incidence based on referral
cytology were as follows at 3 and 5 years, respectively: normal, 0.7% and 0.9%; ASCUS,
4.31% and 5.6%; and LSIL, 5.9% and 7.2%. Three- and 5-year incidence of invasive cancer
were 0% and 0.02% for normal cytology, 0.08% and 0.11% for ASCUS, and 0.04% and 0.07%
for LSIL, respectively. Stratifying risk by biopsy result at initial colposcopy, 3- and
5-year CIN3 incidences were 2.85% and 3.81% with a negative biopsy, 7.09% and 8.32%
with an LSIL biopsy, and 4.11% and 5.2% when no biopsy was done, respectively. Three-
and 5-year incidence of invasive cancer was 0% and 0.05% after a negative biopsy,
0% and 0% after LSIL biopsy, and 0.05% and 0.08% when no biopsy was done, respectively.
Conclusion
When initial colposcopy is done after a low-grade screening cytology result and <CIN2
is identified, the risk of CIN3 and invasive cancer is low, particularly when biopsies
indicate LSIL. Surveillance strategies should balance the likelihood of detecting
CIN3 with the potential harms over management with too frequent screening or colposcopic
interventions in low-risk patients.
Résumé
Objectif
Déterminer les risques primaires et cumulatifs de CIN3 et de cancer invasif du col
de l’utérus chez les patientes dont la colposcopie a révélé une < CIN2 après une cytologie
de bas grade (atypie des cellules malpighiennes de signification indéterminée [ASCUS]
ou lésion malpighienne intra-épithéliale de bas grade [LSIL]).
Méthodologie
Cette étude a été menée en reliant les données administratives, y compris les rapports
cytologiques et anatomopathologiques, les registres de cancer et l’historique de facturation
des médecins, afin de former une cohorte populationnelle de participantes chez qui
on a observé une < CIN2 à la colposcopie initiale après une cytologie de bas grade
entre janvier 2012 et décembre 2013. Les risques de CIN3 et de cancer invasif du col
à 3 et 5 ans ont été générés au moyen de la méthode de Kaplan-Meier pour évaluer la
survie globale.
Résultats
Chez les 36 887 participantes à l’étude, l’incidence de CIN3 à 3 et 5 ans selon la
cytologie indicatrice était, respectivement : normale, 0,7 % et 0,9 %; ASCUS, 4,31
% et 5,6 %; et LSIL, 5,9 % et 7,2 %. L’incidence de cancer invasif à 3 et 5 ans était
respectivement de 0 % et 0,02 % dans les cas de cytologie normale; de 0,08 % et 0,11
% pour l’ASCUS; et de 0,04 % et 0,07 % pour la LSIL. Après la stratification du risque
selon le résultat de la biopsie à la colposcopie initiale, l’incidence de CIN3 à 3
et 5 ans était respectivement de 2,85 % et 3,81 % en cas de biopsie négative; de 7,09
% et 8,32 % en cas de résultat de LSIL à la biopsie; et de 4,11 % et 5,2 % lorsqu’aucune
biopsie n’a été réalisée. L’incidence de cancer invasif à 3 et 5 ans était respectivement
de 0 % et de 0,05 % après une biopsie négative; de 0 % et 0 % après un résultat de
LSIL à la biopsie; et de 0,05 % et 0,08 % lorsqu’aucune biopsie n’a été réalisée.
Conclusion
Lorsqu’une colposcopie initiale est réalisée à la suite d’une cytologie de bas grade
et qu’une < CIN2 est observée, les risques de CIN3 et de cancer invasif sont faibles,
en particulier quand la biopsie révèle une LSIL. Dans les stratégies de surveillance,
il y a lieu de viser un juste équilibre entre la probabilité de détecter une CIN3
et les risques des interventions colposcopiques et dépistages trop fréquents dans
la prise en charge des patientes à faible risque.
Keywords
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Article Info
Publication History
Published online: August 07, 2022
Accepted:
June 1,
2022
Received:
April 13,
2022
Footnotes
Disclosures: The authors declare they have nothing to disclose.
All authors have indicated they meet the journal’s requirements for authorship.
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
