[Analysis of risk factors for pathological upgrading after cervical conization in patients with CIN1]

Objective: To explore the risk factors for pathological upgrading after cervical conization in patients with cervical intraepithelial neoplasia 1 (CIN1). Methods: A retrospective cohort study was conducted. A total of 1 416 CIN1 patients who underwent cervical conization in Jiangxi Provincial Maternal and Child Health Hospital from January 2021 to December 2023 were enrolled. According to whether the postoperative pathology was upgraded, they were divided into the pathological upgrading group (156 cases) and the pathological non-upgrading group (1 260 cases). The clinical data of the two groups were collected and compared, and the independent risk factors of pathological upgrading were screened by univariate analysis and multivariate binary logistic regression analysis. Based on binary logistic regression, a nomogram was constructed to predict the individualized probability of postoperative pathological escalation in CIN1 patients. Results: Among the 1 416 CIN1 patients diagnosed preoperatively, the postoperative pathological upgrade rate was 11.02% (156/1 416). Univariate analysis showed that there were statistically significant differences in the proportions of Thin-prep cytologic test (TCT) infection history in the past 5 years, TCT examination results>low-grade squamous intraepithelial lesion (LSIL), the number of lesions involved quadrants >2, and cervical biopsy pathology ≥CIN1 between the pathological upgrading group and the pathological non-upgrading group (all P<0.05). Multivariate logistic regression analysis showed that TCT results >LSIL (OR=4.017, 95%CI: 2.375-6.791; P<0.001), the number of involved quadrants >2 (OR=1.818, 95%CI: 1.257-2.627; P=0.001) were the independent risk factors for pathological upgrading after CIN1 surgery. The nomogram model was constructed based on the above two independent factors. When the patient had the two high-risk features of TCT results >LSIL and the number of involved quadrants >2, the total score reached the full score of 15.72, and the maximum risk of pathological upgrading was 41%. Conclusions: For patients with colposcopic biopsy confirmed CIN1, if TCT results>LSIL and/or lesion involved quadrants>2, the risk of missed high-grade squamous intraepithelial lesion (HSIL) is significantly increased. Therefore, more active diagnosis or treatment strategies should be taken for these high-risk patients. In addition, it is necessary to pay attention to colposcopy in postmenopausal women to reduce the missed diagnosis of HSIL.