title: Subsequent risks for cervical precancer and cancer in women with low-grade squamous intraepithelial lesions unconfirmed by colposcopy-directed biopsy: results from a multicenter, prospective, cohort study.
abstract: OBJECTIVE
  To investigate the natural course of low-grade squamous intraepithelial lesions (LSILs) that cannot be histologically confirmed by colposcopy-directed biopsy.
  
  
  METHODS
  In a multicenter, prospective, cohort study of Japanese women with LSILs, we analyzed the follow-up data from 64 women who had a negative biopsy result at the initial colposcopy (biopsy-negative LSIL) in comparison with those from 479 women who had a histologic diagnosis of cervical intraepithelial neoplasia grade 1 (LSIL/CIN1). Patients were monitored by cytology and colposcopy every 4 months for a mean follow-up period of 39.0 months, with cytologic regression defined as two consecutive negative smears and normal colposcopy.
  
  
  RESULTS
  In women with biopsy-negative LSILs, there were no cases of CIN3 or worse (CIN3+) diagnosed within 2 years; the difference in the 2-year risk of CIN3+ between the two groups was marginally significant (0 vs. 5.5%; P = 0.07). The cumulative probability of cytologic regression within 12 months was much higher in the biopsy-negative LSIL group (71.2 vs. 48.6%; P = 0.0001). The percentage of women positive for high-risk human papillomaviruses (hrHPVs) was significantly lower in the biopsy-negative LSIL group than in the LSIL/CIN1 group (62.1 vs. 78.4%; P = 0.01); however, the 12-month regression rate of biopsy-negative LSIL was similar between hrHPV-positive and -negative women (67.3 vs. 74.4%, P = 0.73).
  
  
  CONCLUSIONS
  In women with biopsy-negative LSILs, the risk of CIN3+ diagnosed within 2 years was low; furthermore, approximately 70% underwent cytologic regression within 12 months, regardless of HPV testing results. Biopsy-negative LSILs may represent regressing lesions rather than lesions missed by colposcopy.
authors: Department of Obstetrics and Gynecology, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, 305-8575, Japan. matsumok@mui.biglobe.ne.jp
authors: Koji
authors: K
authors: Matsumoto
authors: Yasuo
authors: Y
authors: Hirai
authors: Reiko
authors: R
authors: Furuta
authors: Naoyoshi
authors: N
authors: Takatsuka
authors: Akinori
authors: A
authors: Oki
authors: Toshiharu
authors: T
authors: Yasugi
authors: Hiroo
authors: H
authors: Maeda
authors: Akira
authors: A
authors: Mitsuhashi
authors: Takuma
authors: T
authors: Fujii
authors: Kei
authors: K
authors: Kawana
authors: Tsuyoshi
authors: T
authors: Iwasaka
authors: Nobuo
authors: N
authors: Yaegashi
authors: Yoh
authors: Y
authors: Watanabe
authors: Yutaka
authors: Y
authors: Nagai
authors: Tomoyuki
authors: T
authors: Kitagawa
authors: Hiroyuki
authors: H
authors: Yoshikawa
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D003127:Colposcopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000473:pathology; D011230:Precancerous Conditions / Q000209:etiology / Q000473:pathology* / Q000821:virology; D011446:Prospective Studies; D018570:Risk Assessment; D002583:Uterine Cervical Neoplasms / Q000209:etiology / Q000473:pathology* / Q000821:virology; D002578:Uterine Cervical Dysplasia / Q000209:etiology / Q000473:pathology* / Q000821:virology