Outcomes of women with positive oncogenic HPV and reflex cytology showing possible high‐grade squamous intraepithelial lesion.

Autor:	Ng, Hamon Y.K., Tan, Jeffrey H.J., Marceglia, Alexandra H., Bittinger, Sophie, Dundas, Kristy E., Talia, Karen L., Wrede, C. David H.
Předmět:	CERVICAL cancer diagnosis PAPILLOMAVIRUS disease diagnosis EVALUATION of medical care SCIENTIFIC observation CONFIDENCE intervals COLPOSCOPY EARLY detection of cancer CERVICAL intraepithelial neoplasia RETROSPECTIVE studies DISEASE incidence MEDICAL protocols DESCRIPTIVE statistics CHI-squared test CYTOLOGY BODY fluid examination
Zdroj:	Australian & New Zealand Journal of Obstetrics & Gynaecology; Dec2021, Vol. 61 Issue 6, p910-917, 8p
Abstrakt:	Aim: To examine outcomes in women following cervical screening detection of oncogenic human papillomavirus (HPV), with reflex cytology showing possible high‐grade squamous intraepithelial lesion (pHSIL). Materials and methods: A retrospective observational study of 523 women seen in the Royal Women's Hospital Colposcopy Clinic from 1 January 2018 to 31 July 2020. Results: Two hundred eighty‐two (53.9%) women had histology‐confirmed HSIL, encompassing CIN2 or worse (CIN2+), including seven cancers (1.3%) and two adenocarcinoma in situ (AIS) (0.4%). In 81.2% (229/282) of women with CIN2+, this was detected on cervical biopsy at initial colposcopy, with another 8.9% (25/282) of CIN2+ detected at cervical excision following initial colposcopy and the remaining 9.9% (28/282) at follow‐up colposcopy thereafter. When discordant cervical biopsy results were discussed at multidisciplinary meeting (MDM), 66.7% of women with pHSIL cytology upgraded to definite HSIL were found to have CIN2+, but only 20.8% when pHSIL cytology was retained and none when downgraded to low‐grade (LSIL) or normal. No significant difference was found in the proportion of CIN2+ based on patient age above or below 40, HPV16 and/or 18 versus non 16/18, or whether discordant findings were reviewed at MDM. Conclusions: We propose a pathway for management of women with positive oncogenic HPV and reflex pHSIL cytology. MDM review is recommended when CIN2+ is not identified on cervical biopsy at initial colposcopy. Conservative management is safe with low risk of CIN2+ when LBC prediction of pHSIL is confirmed or downgraded at MDM with no high‐grade change on colposcopy or repeat cytology. [ABSTRACT FROM AUTHOR]
Databáze:	Complementary Index
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