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Risk factors for HPV persistence and cytology anomalies at follow‐up after treatment for cervical dysplasia
Author(s) -
Rizzuto Ivana,
Nalam Mythili,
Jiang Jason,
Linder Anders,
Rufford Barnaby
Publication year - 2018
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12431
Subject(s) - medicine , dysplasia , cervical intraepithelial neoplasia , relative risk , cytology , confidence interval , retrospective cohort study , gynecology , hpv infection , obstetrics , cervical cancer , pathology , cancer
Objective To evaluate predictor factors of persistent cytologic dysplasia and/or high‐risk human papillomavirus (hr HPV ) infection at 6‐month follow‐up and at 3–5 years during routine cervical smear testing. Methods The present retrospective study included data from women treated for cervical dysplasia by large loop excision of the transformation zone ( LLETZ ) at Ipswich Hospital, UK , between January 1 and December 31, 2012. Age, parity, smoking, status of resection margins, and previous LLETZ treatment were evaluated by multivariate analyses. Results There were 192 patients included in the study. There was no association between age (relative risk [ RR ] 1.0, 95% confidence interval [ CI ] 0.80–1.23; P >0.99), smoking ( RR 1.12, 95% CI 0.79–1.59; P =0.516), or parity ( RR 1.10, 95% CI 0.88–1.38; P =0.382) and abnormal cytology and/or persistent hr HPV infection at 6 months. There was an association between positive margins ( RR 1.64, 95% CI 1.20–2.24; P =0.003), previous LLETZ ( RR 3.48, 95% CI 1.69–7.15; P <0.001), and dyskaryosis and/or hr HPV infection at 6 months. Only previous LLETZ treatment remained associated with abnormal cytology and persistent hr HPV infection at 3–5 years ( RR 6.37, 95% CI 3.56–11.3; P <0.001). Conclusion Clinical factors, including age, smoking, treatment history, and status of surgical margins, could help to determine the risk of dysplasia recurrence and facilitate patient follow‐up based on risk stratification.