Article Data

  • Views 731
  • Dowloads 142

Original Research

Open Access

The prevalence of abnormal pap smear in women with pelvic inflammatory disease and determine the risk factors of cervical intra-epithelial neoplasia 2/3

  • Hye-yon Cho1
  • Soobin Yim1
  • Inji Yeo1
  • Min Sun Kyung1,*,

1Hallym University Dogtan Sacred Heart Hospital, Keunjaebong-gil 7, Hwaseong-si, 18450 Kyonggi-do, Korea

DOI: 10.31083/j.ejgo.2021.01.2269 Vol.42,Issue 1,February 2021 pp.105-109

Submitted: 12 October 2020 Accepted: 19 November 2020

Published: 15 February 2021

*Corresponding Author(s): Min Sun Kyung E-mail: msfeel@hallym.or.kr

Abstract

Objective: To investigate the prevalence of abnormal Pap (ASCUS or worse) and HPV infection in women with pelvic inflammatory disease (PID) and assess the risk factors for CIN2/3. Methods: Retrospective chart review of 249 women who were admitted to the hospital for the treatment of PID between 2013 and 2019 was performed. Patients’ characteristics including age, parity, sexually transmitted disease (STD) infection, Pap results, human papilloma virus (HPV) infection, Nugent score, C-reactive protein (CRP), and neutrophil to lymphocyte ratio (NLR) were retrieved. Clinical characteristics were compared between group 1 (women with normal pap; N = 159) and group 2 (women with abnormal Pap; N = 90). Results: Of 249 women, abnormal Pap rate was 36.1% and HPV positivity was 41.0%. Of those with HPV infection, 78.4% had high-risk HPV subtypes. Group 2 was significantly associated with high-risk HPV infection (P < 0.0001) and low NLR (P = 0.047). 74 women underwent colposcopy-directed punch biopsy, and 14 showed CIN2/3. Multivariate analysis showed that high-risk HPV infection (P = 0.040; 95% CI 1.081-32.389) and low Nugent score ( 3) (P = 0.003; 95% CI 2.130-39.807) were independent risk factors of CIN2/3 in women with abnormal Pap and PID. Conclusions: Women with PID showed high prevalence of abnormal Pap. Nonetheless, high-risk HPV infection and low Nugent score are the most reliable factors in determining colposcopy for the diagnosis of CIN2/3.


Keywords

Abnormal Pap; Cervical intraepithelial neoplasia (CIN); Human papilloma virus (HPV); Pelvic in􀀁lammatory disease (PID)


Cite and Share

Hye-yon Cho,Soobin Yim,Inji Yeo,Min Sun Kyung. The prevalence of abnormal pap smear in women with pelvic inflammatory disease and determine the risk factors of cervical intra-epithelial neoplasia 2/3. European Journal of Gynaecological Oncology. 2021. 42(1);105-109.

References

[1] Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA: A Cancer Journal for Clinicians. 2005; 55: 74-108.

[2] Arbyn M, Weiderpass E, Bruni L, de Sanjosé S, Saraiya M, Ferlay J, et al. Estimates of incidence and mortality of cervical cancer in 2018: a worldwide analysis. The Lancet Global Health. 2020; 8: e191-e203.

[3] Bruni L AG, Serrano B, Mena M, Gómez D, Muñoz J, Bosch FX, de Sanjosé S. Human papillomavirus and related diseases in republic of Korea. ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). 2019.

[4] Kjaer SK, Frederiksen K, Munk C, Iftner T. Long-term absolute risk of cervical intraepithelial neoplasia grade 3 or worse following human papillomavirus infection: role of persistence. Journal of the National Cancer Institute. 2010; 102: 1478-1488.

[5] Rodriguez AC, Schiffman M, Herrero R, Hildesheim A, Bratti C, Sherman ME, et al. Longitudinal study of human papillomavirus persistence and cervical intraepithelial neoplasia grade 2/3: critical role of duration of infection. Journal of the National Cancer Institute. 2010; 102: 315-324.

[6] International Collaboration of Epidemiological Studies of Cervical Cancer. Comparison of risk factors for invasive squamous cell carcinoma and adenocarcinoma of the cervix: collaborative reanalysis of individual data on 8,097 women with squamous cell carcinoma and 1,374 women with adenocarcinoma from 12 epidemiological studies. International Journal of Cancer. 2007; 120: 885-891.

[7] Dugué P, Rebolj M, Garred P, Lynge E. Immunosuppression and risk of cervical cancer. Expert Review of Anticancer Therapy. 2013; 13: 29-42.

[8] Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. Journal of Clinical Microbiology. 1991; 29: 297-301.

[9] Lee EH, Um TH, Chi H, Hong Y, Cha YJ. Prevalence and distribution of human papillomavirus infection in Korean women as determined by restriction fragment mass polymorphism assay. Journal of Korean Medical Science. 2012; 27: 1091.

[10] Smith JS, Lindsay L, Hoots B, Keys J, Franceschi S, Winer R, et al. Human papillomavirus type distribution in invasive cervical cancer and high-grade cervical lesions: a meta-analysis update. International Journal of Cancer. 2007; 121: 621-632.

[11] Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratislavske Lekarske Listy. 2001; 102: 5-14.

[12] Acmaz G, Aksoy H, Unal D, Ozyurt S, Cingillioglu B, Aksoy U, et al. Are Neutrophil/lymphocyte and platelet/lymphocyte ratios associated with endometrial precancerous and cancerous lesions in patients with abnormal uterine bleeding? Asian Pacific Journal of Cancer Prevention. 2014; 15: 1689-1692.

[13] Wang GY, Yang Y, Li H, Zhang J, Jiang N, Li MR, et al. A scoring model based on neutrophil to lymphocyte ratio predicts recurrence of HBV-associated hepatocellular carcinoma after liver transplantation. PLoS ONE. 2011; 6: e25295.

[14] Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002; 420: 860-867.

[15] Babu SN, Chetal G, Kumar S. Macrophage migration inhibitory factor: a potential marker for cancer diagnosis and therapy. Asian Pacific Journal of Cancer Prevention. 2012; 13: 1737-1744.

[16] Mantovani A, Allavena P, Sica A, Balkwill F. Cancer-related inflammation. Nature. 2008; 454: 436-444.

[17] Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010; 140: 883-899.

[18] McMillan DC. The systemic inflammation-based Glasgow Prognostic Score: a decade of experience in patients with cancer. Cancer Treatment Reviews. 2013; 39: 534-540.

[19] Guthrie GJK, Charles KA, Roxburgh CSD, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Critical Reviews in OncologyHematology. 2013; 88: 218-230.

[20] Templeton AJ, McNamara MG, Šeruga B, Vera-Badillo FE, Aneja P, Ocaña A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. Journal of the National Cancer Institute. 2014; 106: dju124.

[21] Chun S, Shin K, Kim KH, Kim HY, Eo W, Lee JY, et al. The neutrophil-lymphocyte ratio predicts recurrence of cervical intraepithelial neoplasia. Journal of Cancer. 2017; 8: 2205-2211.

[22] Huang Q, Man Q, Hu J, Yang Y, Zhang Y, Wang W, et al. Prognostic significance of neutrophil-to-lymphocyte ratio in cervical cancer: a systematic review and meta-analysis of observational studies. Oncotarget. 2017; 8: 16755-16764.

[23] Dey S, Pahwa P, Mishra A, Govil J, Dhillon PK. Reproductive tract infections and premalignant lesions of cervix: evidence from women presenting at the Cancer Detection Centre of the Indian Cancer Society, Delhi, 2000-2012. The Journal of Obstetrics and Gynecology of India. 2016; 66: 441-451.

[24] Depuydt CE, Leuridan E, Van Damme P, Bogers J, Vereecken AJ, Donders GG. Epidemiology of Trichomonas vaginalis and human papillomavirus infection detected by real-time PCR in flanders. Gynecologic and Obstetric Investigation. 2010; 70: 273-280.

[25] Ghosh I, Muwonge R, Mittal S, Banerjee D, Kundu P, Mandal R, et al. Association between high risk human papillomavirus infection and coinfection with Candida spp. and Trichomonas vaginalis in women with cervical premalignant and malignant lesions. Journal of Clinical Virology. 2017; 87: 43-48.

[26] Burd EM. Human papillomavirus and cervical cancer. Clinical Microbiology Reviews. 2003; 16: 1-17.

[27] So KA, Hong JH, Lee JK. Human papillomavirus prevalence and type distribution among 968 women in South Korea. Journal of Cancer Prevention. 2016; 21: 104-109.

[28] Fontham ETH, Wolf AMD, Church TR, Etzioni R, Flowers CR, Herzig A, et al. Cervical cancer screening for individuals at average risk: 2020 guideline update from the American cancer society. CA: A Cancer Journal for Clinicians. 2020; 70: 321-346.

[29] Perkins RB, Guido RS, Castle PE, Chelmow D, Einstein MH, Garcia F, et al. 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease. 2020; 24: 102-131.

[30] Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, 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: A Cancer Journal for Clinicians. 2012; 62: 147-172.

[31] Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, et al. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease. 2013; 17: S1-S27.


Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,500 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Biological Abstracts Easily discover critical journal coverage of the life sciences with Biological Abstracts, produced by the Web of Science Group, with topics ranging from botany to microbiology to pharmacology. Including BIOSIS indexing and MeSH terms, specialized indexing in Biological Abstracts helps you to discover more accurate, context-sensitive results.

Google Scholar Google Scholar is a freely accessible web search engine that indexes the full text or metadata of scholarly literature across an array of publishing formats and disciplines.

JournalSeek Genamics JournalSeek is the largest completely categorized database of freely available journal information available on the internet. The database presently contains 39226 titles. Journal information includes the description (aims and scope), journal abbreviation, journal homepage link, subject category and ISSN.

Current Contents - Clinical Medicine Current Contents - Clinical Medicine provides easy access to complete tables of contents, abstracts, bibliographic information and all other significant items in recently published issues from over 1,000 leading journals in clinical medicine.

BIOSIS Previews BIOSIS Previews is an English-language, bibliographic database service, with abstracts and citation indexing. It is part of Clarivate Analytics Web of Science suite. BIOSIS Previews indexes data from 1926 to the present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Submission Turnaround Time

Conferences

Top