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Presence of koilocytosis in low‐grade smears of high‐risk HPV ‐positive women is a negative predictor for cervical intraepithelial neoplasia grade 3 or more
Author(s) -
Siebers A. G.,
Linden H.,
Vedder J. E. M.,
Bekkers R. L. M.,
Melchers W. L. G.,
Bulten J.
Publication year - 2018
Publication title -
cytopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.512
H-Index - 48
eISSN - 1365-2303
pISSN - 0956-5507
DOI - 10.1111/cyt.12536
Subject(s) - koilocyte , medicine , cervical intraepithelial neoplasia , squamous intraepithelial lesion , odds ratio , gynecology , population , cancer , cervical cancer , environmental health
Objective The Netherlands converted to high‐risk (hr) HPV ‐based screening in 2017. An increase in referral of hr HPV ‐positive women with low risk for cervical intraepithelial neoplasia grade 3 or more ( CIN 3+) is anticipated and reduction of unjustified referrals will have priority. The relevance of koilocytosis in relation to the underlying risk of high‐grade CIN in a primary HPV screening setting is unclear. The aim was to investigate whether the risk for CIN 3+ differs between hr HPV ‐positive atypical squamous cells of undetermined significance ( ASC ‐ US )/ low‐grade squamous intraepithelial lesion (LSIL) with or without koilocytosis. Methods Retrospective cohort study, using data from the Dutch national pathology database ( PALGA ). The population was 1201 hr HPV ‐positive women with cytological diagnosis of ASC ‐ US / LSIL . Reporting of koilocytosis was assessed as well as detection rates of CIN 1 or less, CIN 2 and CIN 3+ for ASC ‐ US / LSIL cytology stratified by presence or absence of koilocytosis. Crude and adjusted odds ratios were determined. Results Koilocytosis was present in 40.1% of ASC ‐ US and 45.9% of LSIL cases. CIN 3+ is significantly less often found when koilocytosis is present (7.8% for hr HPV ‐positive ASC ‐ US with‐ vs 15.8% without koilocytosis). For hr HPV ‐positive LSIL this was 11.7% vs 20.2%. The crude and adjusted odds ratios for CIN 3+ was 0.45 for hr HPV ‐positive ASC ‐ US and 0.52 for hr HPV ‐positive LSIL . Conclusions The presence of koilocytosis is a negative predictor of CIN 3+. The risk of hr HPV ‐positive ASC ‐ US with koilocytosis is in the same range as hr HPV ‐positive/cytology negative cases and in a setting of primary hr HPV screening these cases could be followed conservatively by repeat cytology. The results should be confirmed by the first data from the Dutch HPV ‐based screening programme.