Natural History of Squamous Intraepithelial Lesions in Pregnancy and Mode of Delivery

Schuster, Stefanie; Joura, Elmar A.; Kohlberger, Petra

doi:10.21873/anticanres.12496

Cited by 8 publications

(12 citation statements)

References 17 publications

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“…However, these studies show large disparities in terms of diagnostic criteria and therapeutic management. Considering all grades of dysplasia, caution should be paid to the interpretation of these data, since overall regression may design initial high-grade or low-grade lesions [6,11,[14][15][16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

Gomez

Balaya

Lepigeon

et al. 2021

JCM

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Objective: The aim of this study was to describe the evolution of high-grade cervical dysplasia during pregnancy and the postpartum period and to determine factors associated with dysplasia regression. Methods: Pregnant patients diagnosed with high-grade lesions were identified in our tertiary hospital center. High-grade lesions were defined either cytologically, by high squamous intraepithelial lesion/atypical squamous cells being unable to exclude HSIL (HSIL/ASC-H), or histologically, with cervical intraepithelial neoplasia (CIN) 2+ (all CIN 2 and CIN 3) during pregnancy. Postpartum regression was defined cytologically or histologically by at least a one-degree reduction in severity from the antepartum diagnosis. A logistic regression model was applied to determine independent predictive factors for high-grade cervical dysplasia regression after delivery. Results: Between January 2000 and October 2017, 79 patients fulfilled the inclusion criteria and were analyzed. High-grade cervical lesions were diagnosed by cytology in 87% of cases (69/79) and confirmed by histology in 45% of those (31/69). The overall regression rate in our cohort was 43% (34/79). Univariate analysis revealed that parity (p = 0.04), diabetes (p = 0.04) and third trimester cytology (p = 0.009) were associated with dysplasia regression. Nulliparity (OR = 4.35; 95%CI = (1.03–18.42); p= 0.046) was identified by multivariate analysis as an independent predictive factor of high-grade dysplasia regression. The presence of HSIL on third-trimester cervical cytology (OR = 0.17; 95%CI = (0.04–0.72); p = 0.016) was identified as an independent predictive factor of high-grade dysplasia persistence at postpartum. Conclusion: Our regression rate was high, at 43%, for high-grade cervical lesions postpartum. Parity status may have an impact on dysplasia regression during pregnancy. A cervical cytology should be performed at the third trimester to identify patients at risk of CIN persistence after delivery. However, larger cohorts are required to confirm these results.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

Gomez

Balaya

Lepigeon

et al. 2021

JCM

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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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Cervical cancer in pregnancy: Analysis of the literature and innovative approaches

Perrone

Bovicelli

D’Andrilli

et al. 2019

Journal Cellular Physiology

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Cervical cancer is one of the most common gynecological malignancies diagnosed during pregnancy although, fortunately, it is a rare event. In majority of cases, the management of cervical cancer in pregnant women is not different from nonpregnant women and prognosis seems not compromised by pregnancy. The association between cancer and pregnancy appears to be a significant challenge for women and specialists and the decisions about therapy must be individualized and taken by a multidisciplinary team. This review is focused on cervical cancer in pregnancy. The aim is to discuss the diagnosis, potential biomarkers and molecular aspects, therapeutic approaches, and prognosis from intraepithelial cervical neoplasia to invasive cervical cancer (early and advanced stages) in different gestational ages. We provide an overview of the current literature regarding the treatment strategies of concurrent pregnancy and cervical cancer cases and we propose some clinical advices to help clinicians to manage this condition. A mention about the effects of the conservative therapy (as conization) on fertility, the human papillomavirus vaccine in pregnant women and our center's experience with obstetrical and oncological outcomes are reported.

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Natural History of Squamous Intraepithelial Lesions in Pregnancy and Mode of Delivery

Abstract: The mode of delivery does not significantly influence the natural history of cervical dysplastic lesions in pregnant women. The numbers of spontaneous regressions to normal cervical cytology during pregnancy were similar in both groups.

Cited by 8 publications

References 17 publications

Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

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

Cervical cancer in pregnancy: Analysis of the literature and innovative approaches

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