High-grade squamous intraepithelial lesion in women aged <30 years has a prevalence pattern resembling low-grade squamous intraepithelial lesion

Authors

  • Diama B. Vale MD,

    1. School of Medicine, Rondonia Federal University, Rondonia, Brazil
    2. School of Medicine, Campinas State University, Campinas, Brazil
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  • Maria C. Westin MD,

    1. School of Medicine, Campinas State University, Campinas, Brazil
    2. Dr. Jose Aristodemos Pinotti Women's Hospital, Campinas State University, Campinas, Brazil
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  • Luiz C. Zeferino MD, PhD

    Corresponding author
    1. School of Medicine, Campinas State University, Campinas, Brazil
    2. Dr. Jose Aristodemos Pinotti Women's Hospital, Campinas State University, Campinas, Brazil
    • Corresponding author: Luiz C. Zeferino, MD, PhD, Department of Obstetrics and Gynecology, Oncology Division, Universidade Estadual de Campinas, Rua Alexander Fleming 101, CEP 13083-881, Campinas-SP, Brazil; Fax: (011) 55-19-3521-9424; zeferino@fcm.unicamp.br

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Abstract

BACKGROUND

Cervical cytology is the cervical cancer screening test for women aged <30 years because of the low specificity of human papillomavirus tests in this age group. The Bethesda System classifies cervical intraepithelial neoplasia grade 2 (CIN 2) and grade 3 (CIN 3) as high-grade intraepithelial lesions (HSIL). In this study, the authors subclassified cytologic HSIL as suggestive of CIN 2 (HSIL-CIN 2) or CIN 3 (HSIL-CIN 3) and evaluated whether there was a correlation between these findings and age for screened and unscreened women.

METHODS

The study included 2,002,472 cervical smears collected from women who had at least 1 previous test (screened) and 217,826 previously untested women (unscreened). The laboratory has been using the Bethesda System since 1998 with the subcategorization of HSIL-CIN 2 and HSIL-CIN 3.

RESULTS

For unscreened women, the prevalence of low-grade intraepithelial lesion (LSIL) and HSIL-CIN 2 decreased with age, whereas the prevalence of HSIL-CIN 3 increased. The prevalence of HSIL-CIN 2 was greater than that of HSIL-CIN 3 for women up to age 29 years (prevalence ratio [PR], 4.73; 95% confidence interval [CI], 3.90-5.75) and lower for the groups ages 30 to 49 years (PR, 0.66; 95% CI, 0.50-0.87) and ≥50 years (PR, 0.21; 95% CI, 0.12-0.36). For screened women, the prevalence of HSIL-CIN 2 also was greater in the group aged ≤29 years (PR, 2.72; 95% CI, 2.49-2.97).

CONCLUSIONS

The prevalence pattern of HSIL suggestive of CIN 2 resembled the pattern observed in LSIL and was more prevalent than HSIL suggestive of CIN 3 in younger women. The impact of screening was less evident when HSIL was suggestive of CIN 2. A conservative approach for younger women who have HSIL is important for management guidance. Cancer (Cancer Cytopathol) 2013;121:576–581. © 2013 American Cancer Society.

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