Follow-up of women with cervical cytological abnormalities showing atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion: a nationwide cohort study

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• 作者：Karin Sundstr&ouml ; m ; MD ; PhD^a ; Donghao Lu ; MD^b ; K. Miriam Elfstr&ouml ; m ; PhD^a ; Jiangrong Wang ; MSc^b ; Bengt Andrae ; MD^b ; ^c ; Joakim Dillner ; MD ; PhD^a ; ^b ; Pä ; r Spar&eacute ; n ; PhD^b ; ^{par.sparen@ki.se}
• 关键词：atypical squamous cells of undetermined significance ; cervical cancer ; comparative effectiveness ; low-grade squamous intraepithelial lesion ; screening
• 刊名：American Journal of Obstetrics and Gynecology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：216
• 期：1
• 页码：48.e1-48.e15
• 全文大小：692 K
• 卷排序：216

文摘

Atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion in abnormal cervical cytology among young women in cervical cancer screening is an increasing health burden, and comparative effectiveness studies of different management options for such diagnoses are needed.ObjectiveThe objective of the study was to compare the incidence of invasive cervical cancer, following different management options pursued after an atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion index smear.Study DesignIn this nationwide cohort study, we included all women aged 22-50 years and resident in Sweden 1989–2011 and with at least 1 cervical smear registered during the study period (n = 2,466,671). Follow-up of a first atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion cytological diagnosis within 25 months was classified as repeat cytology, colposcopy/biopsy, or without further assessment. Incidence rate ratios and 95% confidence intervals of subsequent cervical cancer within 6.5 years following atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion were estimated using Poisson regression by age group and management strategy.ResultsWomen managed with repeat cytology within 6 months after atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion cytology had a similar risk of cervical cancer compared with colposcopy/biopsy (incidence rate ratio, 1.1, 95% confidence interval, 0.5–2.5, and incidence rate ratio, 2.0, 95% confidence interval, 0.6–6.5, respectively) among women aged 22–27 years. For women aged 28 years and older, women managed with repeat cytology had a higher risk for cervical cancer than women managed with colposcopy/biopsy.ConclusionOur findings suggest that women with a first cytological diagnosis of atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion up to age 27 years may indeed be safely followed up with repeat cytology within 6 months. A large amount of colposcopies that are currently performed in this group, therefore, could safely be discontinued.