High-grade CIN on cervical biopsy and predictors of the subsequent cone histology results in women undergoing immediate conization

Luca Giannella, Kabala Mfuta, Giorgio Gardini, Teresa Rubino, Cristina Fodero, Sonia Prandi

Research output: Contribution to journalArticle

Abstract

Objective To identify the clinical/colposcopic variables that associate with low-grade/negative cone histology in screening-age women undergoing conization for high-grade cervical intraepithelial neoplasia (CIN). The follow-up outcomes of study participants were also compared. Study design In this retrospective cohort study, 585 consecutive screening-age women who underwent immediate conization for CIN2-3 were divided according to cone histology (CIN2+ versus ≤CIN1) and assessed in relation to clinical/colposcopic variables by univariate and multivariate analyses. Results Low-grade [adjusted odds ratio (AOR) = 52.67, 95% confidence interval (CI) 22.49-123.34] or normal (AOR = 9.81, 95% CI 2.38-40.44) colposcopic impression and CIN2 on cervical biopsy (AOR = 19.59, 95% CI 6.62-57.92) associated with CIN1/negative cone histology. Multivariate analysis also showed that Eastern European ethnicity (AOR = 0.13, 95% CI 0.03-0.52) and high-risk-Human Papillomavirus (hr-HPV)-positivity (AOR = 0.38, 95% CI 0.17-0.87), associated with CIN2+ cone histology. Overall, there were no significant differences between the two groups in terms of high-grade recurrence during the 2-year follow-up. Conversely, a higher rate of high-grade recurrence was present in CIN2-3 (positive cone margins) than in CIN1/negative cone histology (21.9% versus 7.4%, P = 0.008, respectively). Conclusion The presence of CIN2 on cervical biopsy and a low-grade colposcopic impression were predictive of a minor cone histology, unless the subject was of East European ethnicity or was positive for hr-HPV test. Given the follow-up outcomes, the same women need to perform a close monitoring. However, positive cone margins in women with CIN2-3 cone histology seem to define a population at greater risk of high-grade recurrence.

Original languageEnglish
Pages (from-to)68-74
Number of pages7
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume186
DOIs
Publication statusPublished - Mar 1 2015

Fingerprint

Conization
Cervical Intraepithelial Neoplasia
Histology
Biopsy
Odds Ratio
Confidence Intervals
Recurrence
Multivariate Analysis
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)

Keywords

  • Cervical biopsy
  • Cervical intraepithelial neoplasia
  • Cone histology
  • Conization
  • Discrepancy
  • LEEP

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine
  • Medicine(all)

Cite this

High-grade CIN on cervical biopsy and predictors of the subsequent cone histology results in women undergoing immediate conization. / Giannella, Luca; Mfuta, Kabala; Gardini, Giorgio; Rubino, Teresa; Fodero, Cristina; Prandi, Sonia.

In: European Journal of Obstetrics and Gynecology and Reproductive Biology, Vol. 186, 01.03.2015, p. 68-74.

Research output: Contribution to journalArticle

Giannella, Luca ; Mfuta, Kabala ; Gardini, Giorgio ; Rubino, Teresa ; Fodero, Cristina ; Prandi, Sonia. / High-grade CIN on cervical biopsy and predictors of the subsequent cone histology results in women undergoing immediate conization. In: European Journal of Obstetrics and Gynecology and Reproductive Biology. 2015 ; Vol. 186. pp. 68-74.
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abstract = "Objective To identify the clinical/colposcopic variables that associate with low-grade/negative cone histology in screening-age women undergoing conization for high-grade cervical intraepithelial neoplasia (CIN). The follow-up outcomes of study participants were also compared. Study design In this retrospective cohort study, 585 consecutive screening-age women who underwent immediate conization for CIN2-3 were divided according to cone histology (CIN2+ versus ≤CIN1) and assessed in relation to clinical/colposcopic variables by univariate and multivariate analyses. Results Low-grade [adjusted odds ratio (AOR) = 52.67, 95{\%} confidence interval (CI) 22.49-123.34] or normal (AOR = 9.81, 95{\%} CI 2.38-40.44) colposcopic impression and CIN2 on cervical biopsy (AOR = 19.59, 95{\%} CI 6.62-57.92) associated with CIN1/negative cone histology. Multivariate analysis also showed that Eastern European ethnicity (AOR = 0.13, 95{\%} CI 0.03-0.52) and high-risk-Human Papillomavirus (hr-HPV)-positivity (AOR = 0.38, 95{\%} CI 0.17-0.87), associated with CIN2+ cone histology. Overall, there were no significant differences between the two groups in terms of high-grade recurrence during the 2-year follow-up. Conversely, a higher rate of high-grade recurrence was present in CIN2-3 (positive cone margins) than in CIN1/negative cone histology (21.9{\%} versus 7.4{\%}, P = 0.008, respectively). Conclusion The presence of CIN2 on cervical biopsy and a low-grade colposcopic impression were predictive of a minor cone histology, unless the subject was of East European ethnicity or was positive for hr-HPV test. Given the follow-up outcomes, the same women need to perform a close monitoring. However, positive cone margins in women with CIN2-3 cone histology seem to define a population at greater risk of high-grade recurrence.",
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T1 - High-grade CIN on cervical biopsy and predictors of the subsequent cone histology results in women undergoing immediate conization

AU - Giannella, Luca

AU - Mfuta, Kabala

AU - Gardini, Giorgio

AU - Rubino, Teresa

AU - Fodero, Cristina

AU - Prandi, Sonia

PY - 2015/3/1

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N2 - Objective To identify the clinical/colposcopic variables that associate with low-grade/negative cone histology in screening-age women undergoing conization for high-grade cervical intraepithelial neoplasia (CIN). The follow-up outcomes of study participants were also compared. Study design In this retrospective cohort study, 585 consecutive screening-age women who underwent immediate conization for CIN2-3 were divided according to cone histology (CIN2+ versus ≤CIN1) and assessed in relation to clinical/colposcopic variables by univariate and multivariate analyses. Results Low-grade [adjusted odds ratio (AOR) = 52.67, 95% confidence interval (CI) 22.49-123.34] or normal (AOR = 9.81, 95% CI 2.38-40.44) colposcopic impression and CIN2 on cervical biopsy (AOR = 19.59, 95% CI 6.62-57.92) associated with CIN1/negative cone histology. Multivariate analysis also showed that Eastern European ethnicity (AOR = 0.13, 95% CI 0.03-0.52) and high-risk-Human Papillomavirus (hr-HPV)-positivity (AOR = 0.38, 95% CI 0.17-0.87), associated with CIN2+ cone histology. Overall, there were no significant differences between the two groups in terms of high-grade recurrence during the 2-year follow-up. Conversely, a higher rate of high-grade recurrence was present in CIN2-3 (positive cone margins) than in CIN1/negative cone histology (21.9% versus 7.4%, P = 0.008, respectively). Conclusion The presence of CIN2 on cervical biopsy and a low-grade colposcopic impression were predictive of a minor cone histology, unless the subject was of East European ethnicity or was positive for hr-HPV test. Given the follow-up outcomes, the same women need to perform a close monitoring. However, positive cone margins in women with CIN2-3 cone histology seem to define a population at greater risk of high-grade recurrence.

AB - Objective To identify the clinical/colposcopic variables that associate with low-grade/negative cone histology in screening-age women undergoing conization for high-grade cervical intraepithelial neoplasia (CIN). The follow-up outcomes of study participants were also compared. Study design In this retrospective cohort study, 585 consecutive screening-age women who underwent immediate conization for CIN2-3 were divided according to cone histology (CIN2+ versus ≤CIN1) and assessed in relation to clinical/colposcopic variables by univariate and multivariate analyses. Results Low-grade [adjusted odds ratio (AOR) = 52.67, 95% confidence interval (CI) 22.49-123.34] or normal (AOR = 9.81, 95% CI 2.38-40.44) colposcopic impression and CIN2 on cervical biopsy (AOR = 19.59, 95% CI 6.62-57.92) associated with CIN1/negative cone histology. Multivariate analysis also showed that Eastern European ethnicity (AOR = 0.13, 95% CI 0.03-0.52) and high-risk-Human Papillomavirus (hr-HPV)-positivity (AOR = 0.38, 95% CI 0.17-0.87), associated with CIN2+ cone histology. Overall, there were no significant differences between the two groups in terms of high-grade recurrence during the 2-year follow-up. Conversely, a higher rate of high-grade recurrence was present in CIN2-3 (positive cone margins) than in CIN1/negative cone histology (21.9% versus 7.4%, P = 0.008, respectively). Conclusion The presence of CIN2 on cervical biopsy and a low-grade colposcopic impression were predictive of a minor cone histology, unless the subject was of East European ethnicity or was positive for hr-HPV test. Given the follow-up outcomes, the same women need to perform a close monitoring. However, positive cone margins in women with CIN2-3 cone histology seem to define a population at greater risk of high-grade recurrence.

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KW - Cervical intraepithelial neoplasia

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KW - Conization

KW - Discrepancy

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