Utility of colposcopy in the management of ASCUS and LSIL in women younger than 25-year-old: A retrospective multicenter study

Objective: We aimed to analyze the colposcopy-guided biopsy results in women aged 21-24 years with clinical suspicion for cervical lesion and/or cytological abnormality. Methods: This was a retrospective cohort study conducted on 461 patients undergoing colposcopic examination and biopsy between the ages of 21-24. The colposcopy-guided biopsy results of women with atypical squamous cells of undetermined significance (atypical squamous cells of undetermined significance) cytology were cervical intraepithelial neoplasia (cervical intraepithelial neoplasia) 2 in 9 patients and cervical intraepithelial neoplasia 3 in 5 patients. Results: The colposcopy-guided biopsy results of women with low-grade squamous intraepithelial lesion (low-grade squamous intraepithelial lesion) cytology were cer-vical intraepithelial neoplasia 2 in 17 patients, cervical intraepithelial neoplasia 3 in 10 patients, and invasive cancer in 1 patient. One of the high-grade squamous intraepithelial lesion (high-grade squamous intraepithelial lesion) patients had invasive cervical cancer. The cytology results of women with cervical intraepithelial neoplasia 1 after 6 months from colposcopy-guided biopsy were atypical squamous cells of undetermined significance (n = 11), and low-grade squamous intraepithelial lesion (n = 6). The cytology results of women with cervical intraepithelial neoplasia 1 after 12 months were atypical squamous cells of undetermined significance in 2 women, and low-grade squamous intraepithelial lesion in 2 women. The cytology results after 12 months from colposcopy-guided biopsy were high-grade squamous intraepithelial lesion in 16 of 433 women who underwent follow-up (3.7%). There were no significant statistically differences between cervical intraepithelial neoplasia 2 patients with and without treatment in terms of cytology results at 6 months (p = 1.00). However, there were significant statistically differences between cervical intraepithelial neoplasia 2 patients with and without treatment in terms of cytology results at 12 months (p= 0.042). Conclusions: Colposcopic examination should perform in women aged 21-24 years with atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion due to the possibility of high-grade squamous intraepithelial lesion and invasive cancer.

Cervical intraepithelial neoplasia; Colposcopy; Human papillomavirus.

[1] Mount S.L., Papillo J.L.: “A study of 10,296 pediatric and adoles-cent Papanicolaou smear diagnoses in northern New England”. Pe-diatrics, 1999, 103, 539.

[2] Edelman M., Fox A.S., Alderman E.M., Neal W., Shapiro A., Silver E.J., et al.: “Cervical papanicolaou smear abnormalities in inner city Bronx adolescents: prevalence, progression, and immune modifiers”. Cancer, 1999, 87, 184.

[3] Sasieni P., Adams J., Cuzick J.: “Benefit of cervical screening at different ages: evidence from the UK audit of screening histories”. Br. J. Cancer, 2003, 89, 88.

[4] Saslow D., Solomon D., Lawson H.W., Killackey M., Kulasingam S. L., Cain J., et al.: “American cancer society, American society for colposcopy and cervical pathology, and American society for clinical pathology screening guidelines for the prevention and early detection of cervical cancer”. CA. Cancer J. Clin., 2012, 62, 147.

[5] Curry S.J.: “Screening for cervical cancer: United States preventive services task force recommendation statement”. JAMA., 2018, 320, 674.

[6] ACOG. Practice Bulletin No. 157.: “Cervical cancer screening and prevention”. Obstet. Gynecol., 2016, 127, 1.

[7] Huh W.K., Ault K.A., Chelmow D., Davey D.D., Goulart R.A., Gar-cia F.A., et al.: “Use of primary high-risk human papillomavirus testing for cervical cancer screening: Interim clinical guidance”. Gy-necol. Oncol., 2015, 136, 178.

[8] Massad L.S., Einstein M.H., Huh W.K., Katki H.A., Kinney W.K., Schiffman M., et al.: “2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors”. J. Low. Genit. Tract. Dis., 2013, 17, 1.

[9] Gultekin M., Zayifoglu K.M., Kucukyildiz I., Dundar S., Boztas G., Semra T.H., et al.: “Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women”. Int. J. Cancer, 2017, 142, 1952.

[10] Katki H.A., Schiffman M., Castle P.E., Fetterman B., Poitras N.E., Lorey T., et al.: “Five-year risks of CIN 3+ and cervical cancer among women with HPV testing of ASC-US Pap results”. J. Low. Genit. Tract. Dis., 2013, 17, 36.

[11] Katki H.A., Schiffman M., Castl P.E., Fetterman B., Poitras N.E., Lorey T., et al.: “Five-year risk of CIN 3+ to guide the management of women aged 21 to 24 years”. J. Low. Genit. Tract. Dis., 2013, 17, 64.

[12] Moscicki A.B., Ma Y., Wibbelsman C., Darragh T.M., Powers A., Farhat S., et al.: “Rate of and risks for regression of cervical intraepithelial neoplasia 2 in adolescents and young women”. Obstet. Gynecol., 2010, 116, 1373.

[13] Fuchs K., Weitzen S., Wu L., Phipps M.G., Boardman L.A.: “Man-agement of cervical intraepithelial neoplasia 2 in adolescent and young women”. J. Pediatr. Adolesc. Gynecol., 2007, 20, 269.