Risk Profile of High-grade Cervical Lesions and Cervical Cancer Considering the Combination of Cytology, HPV Genotype, and Age among Women Undergoing Colposcopy

Possati-Resende, Júlio César; Fritsch, Thais Zilles; Souza, Karen Cristina Borba

doi:10.1055/s-0043-1772483

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Revista Brasileira de Ginecologia e Obstetrícia

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Original Article • Rev Bras Ginecol Obstet 45 (11) • 2023 • https://doi.org/10.1055/s-0043-1772483 copy

Risk Profile of High-grade Cervical Lesions and Cervical Cancer Considering the Combination of Cytology, HPV Genotype, and Age among Women Undergoing Colposcopy

Perfil de risco de lesões cervicais de alto grau e câncer cervical considerando a combinação de citologia, genótipo do HPV e idade entre mulheres submetidas a colposcopia

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study aims to establish a risk profile for high-grade cervical lesions and cervical cancer (CIN2 + ) in women undergoing colposcopy at the Hospital do Câncer de Barretos, through the analysis of Human Papillomavirus (HPV) infection, cervical cytology, and patient's age.

Methods

Retrospective cross-sectional study based on a computerized database of women aged ≥ 18 years old who underwent colposcopy at the Prevention Department of the Hospital do Câncer de Barretos from 2017 to 2019.

Results

A total of 3,411 women were included, 58.0% were positive for high-risk-HPV test, with a higher prevalence of CIN2+ for HPV16 (30.3%) and other HPV (45.0%). Cytological findings that suggest invasive cervical cancer (squamous cells or adenocarcinoma), regardless of the status of HPV test, showed 100% diagnosis of CIN2 + , while atypias that suggest high-grade lesions, HSIL and ASC-H, positive for HPV test, showed in 86 and 55.2%, respectively, diagnosis of CIN2 + . ASC-H cytological results among women aged > 40 years old and negative HPV were mainly associated with benign findings. We observed that ≤ CIN1 has a higher prevalence among older women with negative HPV, while for high-grade lesions there is an increase among young women HPV16- and/or 18-positive. In cancer diagnosis, we observed a predominance of HPV 16/18 regardless of the age group.

Conclusion

The highest risks of precursor lesions and cervical cancer were found among women with positive HPV 16/18 tests and severe cytological atypia in population screening tests. In addition, cytological findings of ASC-H HPV negative in women > 40 years old usually represent benign findings in histological investigation.

Keywords
squamous intraepithelial lesions of the cervix; uterine cervical neoplasms; papillomavirus infections; colposcopy; risk

				Mean age (years old)
			n (%)
HPV genotyping	Positive		1979 (58.0)	40.1
HPV genotyping		HPV16	388 (19.6)	38.3
		HPV18	101 (5.1)	40.0
		Other HPV	1177 (59.5)	41.6
		HPV16 and HPV18	12 (0.6)	30.4
		HPV16 and other HPV	214 (10.8)	37.3
		HPV18 and other HPV	68 (3.4)	40.2
		HPV16, HPV18, and other HPV	19 (1.0)	28.4
	Negative		1405 (41.2)	45.7
	Invalid		27 (0.8)	44.9
Cytology	ASC-H		1392 (40.8)	42.3
	AGC		480 (14.1)	43.8
	ASC-US		418 (12.3)	42.8
	HSIL		393 (11.5)	37.9
	LSIL		362 (10.6)	42.0
	NILM		165 (4.8)	45.0
	HSIL (inv)		43 (1.3)	43.9
	Atypical cells of undefined origin		80 (2.3)	46.7
	Endometrial cells^a a Endometrial cells (in a woman ≥ 45 years old.		28 (0.8)	52.7
	Unsatisfactory		24 (0.7)	51.2
	AIS		14 (0.4)	43.1
	SCC		9 (0.3)	49.1
	IA		3 (0.1)	47.7
Final Diagnosis	Benign		2089 (61.2)	45.7
Final Diagnosis	CIN1		344 (10.1)	38.4
	CIN2		174 (5.1)	35.4
	CIN3		627 (18.4)	36.4
	CIN2/3^b b CIN2/3: cervical intraepithelial neoplasia grade 2 or 3, not possible to differentiate.		50 (1.5)	35.6
	Adenocarcinoma in situ		41 (1.2)	39.6
	Invasive adenocarcinoma		7 (0.2)	47.3
	Squamous cell carcinomas		79 (2.3)	43.8
Total			3411 (100)	42.5

Final diagnosis	Total	Positive HPV	hrHPV genotyping		Cytology
Final diagnosis	Total	Positive HPV	HPV 16/18	Other HPV	SCC	IA	AIS	HSIL (inv)	HSIL	ASC-H	Others^* * Others: AGC/ASC-US/ Atypical cells of undefined origin /LSIL/endometrial cells/unsatisfactory/NILM.
Benign	2089	861 (41.2)	239 (27.8)	622 (72.2)	0 (0.0)	0 (0.0)	0 (0.0)	2 (0.1)	70 (3.4)	822 (39.4)	1195 (57.2)
CIN1	344	225 (65.4)	72 (32.0)	153 (68.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	21 (6.1)	142 (41.3)	181 (52.6)
CIN2/3	851	773 (90.8)	393 (50.8)	380 (49.2)	2 (0.2)	1 (0.1)	1(0.1)	29 (3.4)	266 (31.2)	394 (46.3)	158 (18.6)
Cervical cancer	127	120 (94.5)	98 (81.7)	22 (18.3)	7 (5.5)	2 (1.6)	13 (10.2)	12 (9.5)	36 (28.4)	34 (26.8)	23 (18.1)

	≤ CIN1	CIN2	CIN3	Cancer	p-value
	n (%; 95%IC)	n (%; 95%IC)	n (%; 95%IC)	n (%; 95%IC)	p-value
hrHPV genotyping
HPV 16/18	311 (39.7%; 36.3–43.2)	66 (8.4%; 6.6–10.6)	308 (39.3%; 35.9–42.9)	98 (12.5%; 10.3–15.0)	0.00^* * p-value < 0.01.
Other HPV	775 (67.4%; 64.6–70.1)	87 (7.6%; 6.1–9.2)	266 (23.1%; 20.7–25.7)	22 (1.9%; 1.2–2.9)	0.00^* * p-value < 0.01.
Negative HPV	1325 (94.6%; 93.3–95.7)	20 (1.4%; 0.9–2.2)	49 (3.5%; 2.6–4.6)	7 (0.5%; 0.2–1.0)	0.00^* * p-value < 0.01.
Cytology
ASC-H	964 (70.5%; 68.0–72.9)	97 (7.1%; 5.8–8.6)	273 (20.0%; 17.9–22.2)	34 (2.5%; 1.7–3.5)	0.000^* * p-value < 0.01.
AGC	433 (91.2%; 88.2–93.6)	1 (0.2%; 0.0–1.2)	29 (6.1%; 4.1–8.7)	12 (2.5%; 1.3–4.4)	0.000^* * p-value < 0.01.
ASC-US	364 (87.3%; 83.7–90.3)	16 (3.8%; 2.2–6.2)	34 (8.2%; 5.7–11.2)	3 (0.7%; 0.2–2.1)	0.000^* * p-value < 0.01.
HSIL	91 (24.0%; 19.8–28.6)	34 (9.0%; 6.3–12.3)	218 (57.5%; 52.4–62.6)	36 (9.5%; 6.7–12.9)	0.000^* * p-value < 0.01.
LSIL	315 (88.0%; 84.2–91.2)	21 (5.9%; 3.7–8.8)	21 (5.9%; 3.7–8.8)	1 (0.3%; 0.0–1.6)	0.000^* * p-value < 0.01.
NILM	150 (91.5%; 86.1–95.3)	3 (1.8%; 0.4–5.3)	10 (6.1%; 3.0–11.0)	1 (0.6%; 0.0–3.6)	0.000^* * p-value < 0.01.
Atypical cells of undefined origin	63 (78.8%; 68.2–87.1)	0 (0.0%; 0.0–4.5^ One-sided 97.5% confidence interval. )	12 (15.0%; 8.0–24.7)	5 (6.3%; 2.1–14.0)	0.085
HSIL (inv)	2 (4.8%; 0.6–16.2)	2 (4.8%; 0.6–16.2)	26 (61.9%; 45.6–76.4)	12 (28.6%; 15.7–44.6)	0.000^* * p-value < 0.01.
AIS	0 (0.0%; 0.0–23.2^ One-sided 97.5% confidence interval. )	0 (0.0%; 0.0–23.2^ One-sided 97.5% confidence interval. )	1 (7.1%; 0.2–33.9)	13 (92.9%; 66.1–99.8)	0.000^* * p-value < 0.01.
SCC	0 (0.0%; 0.0–33.6^ One-sided 97.5% confidence interval. )	0 (0.0%; 0.0–33.6^ One-sided 97.5% confidence interval. )	2 (22.2%; 2.8–60.0)	7 (77.8%; 40.0–97.1)	0.000^* * p-value < 0.01.
IA	0 (0.0%; 0.0–70.8^ One-sided 97.5% confidence interval. )	0 (0.0%; 0.0–70.8^ One-sided 97.5% confidence interval. )	1 (33.3%; 0.8–90.6)	2 (66.7%; 9.4–99.2)	0.002

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[1] Address for correspondence Júlio César Possati-Resende Antenor Duarte Viléla, 1331, 14784-400, Barretos, SP Brazil (e-mail: julio.possati@uol.com.br).