Predictors of CIN2+ in Patients with PAP III-P (ASC-H): A Cross-Sectional Study

Abstract

Background: This study aims to investigate whether specific characteristics of the patient group with ASC-H (PAP III-p) findings increase the likelihood of clinically significant disease (CIN2+), offering implications for risk-adapted clinical management. Methods: 225 patients with an ASC-H smear presenting to our colposcopy unit between 2014 and 2021 were identified and examined retrospectively. A total of 203 patients were included in the cross-sectional study using multivariate logistic regression. Results: Of the 12 variables that entered the regression model, transformation zone (p = 0.045) and HPV infection (p = 0.005) contributed significantly to predicting CIN2+. A T3 transformation zone had a protective effect, reducing the likelihood of significant pathology. Infection with HPV high risk (non 16/18) or HPV high risk (16/18), on the contrary, increased the likelihood of CIN2+ four times and seven times, respectively, compared to the lower-risk category. Conclusion: A differential approach in the workup of ASC-H cytology is advisable. Younger, premenopausal patients with positive HPV high-risk findings are at a significantly higher risk for CIN2+ lesions than older postmenopausal women with negative high-risk HPV test results. As the risk increases from HPV high-risk non 16/18 to HPV 16/18 infections, using HPV PCR testing is advisable.

relationship between HPV positivity and abnormal cervical cytology changes with age in perimenopausal women

“…Although classification according to age at 30 years is definitely warranted when employing HPV DNA testing in screening, it is unclear if the suggestions for females above thirties are similarly true during the life span of a woman of screening. "Because the rate of pre-neoplastic disease is low (8), few studies of women over age 30 have the power to further stratify by age in order to better inform guidelines" (7)(8)(9)(10)(11) Women with all grades of "pathology-confirmed cervical intraepithelial neoplastic (CIN)" showed a reduction in HR-HPV identification with age, with the most pronounced decline seen for HPV 16 infection, according to a recent study from the ATHENA trial, that contained data on more than thirty five thousand women aged thirty and older. "In the HPV in Perimenopause (HIP) cohort of routinely screened women age 35-60 years, we observed a similar trend of decreasing correlation between HR-HPV detection and cervical abnormalities with increasing age" Our goal was to learn more about the relationship between agerelated aberrant cytology and either HPV and HR-HPV detection (12)(13)(14).…”