Risk Factors Associated with CIN2+ in Spanish Patients with L-SIL/ASCUS Cytology Collected from a Madrid Hospital

Area of Science:

• Gynecologic Oncology
• Cervical Cancer Screening
• Human Papillomavirus (HPV) Research

Background:

• Management of low-grade squamous intraepithelial lesion (LSIL) and atypical squamous cells of undetermined significance (ASCUS) cytology is not standardized.
• Identifying risk factors for high-grade squamous intraepithelial lesions (H-SIL/CIN2+) is crucial for effective patient management.

Purpose of the Study:

• To investigate risk factors associated with H-SIL/CIN2+ in women with ASCUS or LSIL Pap smear results.
• To identify independent predictors for H-SIL/CIN2+ in this patient cohort.

Main Methods:

• A cohort of 1259 women with ASCUS/LSIL cytology underwent colposcopy between 2012 and 2022.
• Risk factors for H-SIL/CIN2+ were analyzed, including High-Risk Human Papillomavirus (HR-HPV) and smoking.
• Colposcopy, with or without dynamic spectral imaging (DSI), followed by biopsies and Loop Electrosurgical Excision Procedure (LEEP) as indicated.

Main Results:

• H-SIL/CIN2+ was detected in 7.7% of women.
• HR-HPV (Odds Ratio [OR] = 2.1), smoking (OR = 2.2), and DSI-assisted colposcopy (OR = 0.6) were associated with H-SIL/CIN2+ detection.
• A combined effect of HR-HPV and smoking showed a higher detection rate (OR = 2.9); HPV 16/18 was the sole independent predictor in multivariate analysis.

Conclusions:

• The presence of HPV 16/18 genotype is the only independent factor predicting H-SIL/CIN2+ in women with ASCUS/LSIL Pap smears.
• Targeted, stricter follow-up is recommended for smokers with ASCUS/LSIL and HR-HPV to prevent unsuspected H-SIL/CIN2+.