Course of cervical intraepithelial neoplasia diagnosed during pregnancy

Grimm, Donata; Lang, I J; Jaeger, Anna; Müller, Volkmar; Kuerti, Sascha; Burandt, Eike; Lezius, Susanne; Schmalfeldt, Barbara; Woelber, Linn

doi:10.1007/s00404-020-05518-1

Cited by 16 publications

(17 citation statements)

References 35 publications

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“…The pathological change and development process of various types of cervical cancer are closely related to many factors, such as virus infection, bad living habits, and so on, which cause serious impacts on the physical life of women. Cervical cancer has now become the “second largest killer” threatening women s health after breast cancer [ 11 ]. Therefore, early screening, early detection, early diagnosis, and early treatment of cervical cancer are particularly important.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of Cervical Intraepithelial Neoplasia and Invasive Cervical Carcinoma by Cervical Biopsy under Colposcopy and Analysis of Factors Influencing

Wang

Mei

2022

Emergency Medicine International

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Objective. To explore the diagnosis of cervical intraepithelial neoplasia (CIN) and invasive cervical carcinoma (ICC) by cervical biopsy under colposcopy and analyze the factors influencing the detection. Methods. The clinical data of 134 CIN confirmed by colposcopy biopsy in our hospital from June 2018 to October 2019 and subsequent LEEP treatment were analyzed retrospectively. All patients were diagnosed pathologically after the operation. The diagnosis of CIN by cervical biopsy under colposcopy was observed. The influencing factors of CIN and ICC detected by colposcopy biopsy were analyzed by the pathological results of loop electrosurgical excision procedure (LEEP) as the gold standard. Results. After LEEP, the number of the no intraepithelial or malignant lesions (NILM) or ICC were higher than that of colposcopy biopsy, and CIN-III was lower than that of colposcopy biopsy, the differences were all statistically significant ( P < 0.05 ). Among the 134 patients, the coincidence rate between colposcopy biopsy and LEEP examination results was 79.10% (106/134), and postoperative pathological findings showed that there were 13 cases (9.70%) with the pathological upgrade and 19 cases (14.18%) with pathological decrease. Multivariate logistic analysis showed that the image quality of colposcopy image, atypical blood vessels, biopsy sampling method, and visible lesion area of the cervix were the independent influencing factors for the detection of CIN and ICC by colposcopy biopsy ( P < 0.05 ). Conclusion. CIN and ICC can be diagnosed by colposcopy cervical biopsy and postoperative histopathology. However, there are still some missed and misdiagnosed cervical biopsies under colposcopy, and the combined detection of the two can further ensure the diagnosis rate. The clinical registration number is E2018091.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of Cervical Intraepithelial Neoplasia and Invasive Cervical Carcinoma by Cervical Biopsy under Colposcopy and Analysis of Factors Influencing

Wang

Mei

2022

Emergency Medicine International

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“…Table 1 shows the characteristics of the included studies. [28][29][30][31][32][33][34][35][36][37] These studies were published between 1999 and 2020 including 10 study populations from different countries. The sample size of these studies ranged from 32 to 160.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…28-34 36 37 After delivery, the actual management of high-grade CIN mainly depended on cytological and histological findings and the risk of cervical cancer. [28][29][30][31][32][33][34][35][36][37] The results of quality assessment for all included studies [28][29][30][31][32][33][34][35][36][37] are shown in online supplemental material 2.…”

Section: Characteristics and Quality Of Included Studiesmentioning

confidence: 99%

“…In total, 10 studies [28][29][30][31][32][33][34][35][36][37] reported regression rates of highgrade CIN during pregnancy. The pooled regression rate for high-grade CIN during pregnancy was 40% (95% CI 35% to 45%), but the heterogeneity among these studies was moderate to high (I 2 =55.0%) (figure 2A).…”

Section: Regression Rates Of High-grade Cin During Pregnancymentioning

confidence: 99%

“…Similarly, due to the existence of moderate-to-high heterogeneity (I 2 =57.1%) among these studies, we employed subgroup meta-analysis to calculate the persistence rate of highgrade CIN during pregnancy. The result of the subgroup meta-analysis of the included studies [28][29][30][31][32][33][34][35][36][37] demonstrates that 40% (95% CI 35% to 45%) of CIN2 and 70% (95% CI 65% to 73%) of CIN3 would be persistent during pregnancy (figure 3B). We found no small study effects existed among these studies by the visual inspection of funnel plots (online supplemental material 4) and the Egger's test (p=0.373).…”

Section: Persistence Rates Of High-grade Cin During Pregnancymentioning

confidence: 99%

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Natural history of histologically confirmed high-grade cervical intraepithelial neoplasia during pregnancy: meta-analysis

Chen

Huang

et al. 2021

BMJ Open

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ObjectivesThis study aimed to conduct a meta-analysis of estimates of the natural history of high-grade cervical intraepithelial neoplasia (CIN) during pregnancy.SettingStudies examining the clinical courses of histologically confirmed high-grade CIN during pregnancy.ParticipantsWe searched PubMed, Web of Science and Embase for eligible studies. Studies were included if they reported the data regarding the natural history of histologically confirmed high-grade CIN during pregnancy. Final estimates were from the meta-analysis of 10 eligible studies.Primary outcome measuresThe regression rate, persistence rate and progression rate of histologically proven untreated high-grade CIN during pregnancy.ResultsA total of 10 original studies were included in this meta-analysis. During pregnancy, the regression rate, persistence rate and progression rate of high-grade CIN were 40% (95% CI 35% to 45%), 59% (95% CI 54% to 64%) and 1% (95% CI 0% to 2%), respectively. There was moderate heterogeneity among the studies. The results of the subgroup meta-analysis show that the pooled rates of regression and persistence during pregnancy were 59% (95% CI 54% to 65%) and 40% (95% CI 35% to 45%) for CIN2, and 29% (95% CI 25% to 33%) and 70% (95% CI 65% to 73%) for CIN3.ConclusionsDuring pregnancy, the majority of histologically confirmed high-grade CIN would be persistent or regressed to lower grade CIN or normal. However, it is still worth noting that a small percentage of high-grade CIN would progress to cervical cancer during pregnancy.

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Evaluation of FAM19A4/miR124‐2 methylation performance in the management of CIN3 diagnosed pregnant women

Hampl

Hesselink²,

Meijer

et al. 2022

Intl Journal of Cancer

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Pregnant women diagnosed with CIN3 have high regression rates after delivery. Biomarkers are needed to only identify pregnant women with progressive CIN requiring treatment to reduce overreferral and overtreatment. In our study we evaluated the performance of the FAM19A4/miR124‐2 methylation test for molecular triage on FFPE samples of CIN3+‐diagnosed pregnant women with known clinical course over time as well in a cross‐sectional setting. In this German multicenter retrospective study biopsy material was collected from pregnant women diagnosed with cervical cancer (n = 16), with CIN3 that progressed to cancer during pregnancy (n = 7), with CIN3 that regressed to CIN1 or less within 6 months after delivery (n = 41), without CIN (n = 16), CIN3 covering 3‐4 quadrants (n = 14) and randomly selected CIN3 (n = 41). FAM19A4/miR124‐2 methylation analysis was performed blinded on first diagnosis. All pregnant women with cervical cancer and with CIN3 progressing to cancer tested positive for FAM19A4/miR124‐2 methylation (100%, 22/22). In the regressing CIN3 group 47.5% and in the group without CIN 21.6% tested methylation positive. High‐volume CIN3 and random selected CIN3 were methylation‐positive in 91.7% and 82.1%, respectively. Methylation levels were significantly higher in progressive CIN3 and cancer compared to the controls (P < .0005). The likelihood ratio of a negative methylation test (LR−) for progressive CIN3+ was 0 (95% CI: 0‐0.208). A negative FAM19A4/miR124‐2 methylation test can rule out progressive CIN disease in pregnant women diagnosed with CIN3. This can help the clinician by managing these pregnant women with conservative follow‐up until after delivery.

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Course of cervical intraepithelial neoplasia diagnosed during pregnancy

Cited by 16 publications

References 35 publications

Diagnosis of Cervical Intraepithelial Neoplasia and Invasive Cervical Carcinoma by Cervical Biopsy under Colposcopy and Analysis of Factors Influencing

Diagnosis of Cervical Intraepithelial Neoplasia and Invasive Cervical Carcinoma by Cervical Biopsy under Colposcopy and Analysis of Factors Influencing

Natural history of histologically confirmed high-grade cervical intraepithelial neoplasia during pregnancy: meta-analysis

Evaluation of FAM19A4/miR124‐2 methylation performance in the management of CIN3 diagnosed pregnant women

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