DISCREPANCY OF CYTOHISTOLOGICAL FINDINGS IN HPV-POSITIVE PREMENOPAUSAL WOMEN: ARE THERE ANY RISK FACTORS INVOLVED?

Problem statement

Discrepancies between abnormal cervical cytology or high-risk Human Papillomavirus (HR-HPV) infection and subsequent histological results are frequent. In this study, we aimed to determine the risk factors involved in the cytohistological discrepancy in premenopausal women with HR-HPV status.

Methods

A retrospective study included all women under 45 years-old (premenopausal) referred to cervical pathology consultation, in a tertiary center, between January 2020 and December 2021.

Three groups were considered: ages under 30 years (G1); ages between 30 and 39 years (G2); and between 40 and 44 (G3).

Cervical cytology results were grouped into low (NILM/ASCUS/LSIL) and high grades (ASC-H/HSIL). If cervical biopsy was performed, it was also grouped into low (CIN1) and high (CIN2/CIN3/CIS) grades. Subsequently, it was evaluated the presence of cytohistological discrepancy.

The primary outcomes comprised an evaluation of women’s characteristics and potential risk factors for cytohistological discrepancy, including parity, smoking, oral contraception, immunosuppressive disease, HPV vaccination, type of HR-HPV infection.

Results

A total of 465 premenopausal women were included, corresponding to 135 women in G1, 212 women in G2, and 118 women in G3. The median age of these women was 27, 34, and 41 years-old, respectively. The prevalence of HPV-16 was the highest in the oldest group (34%), whereas 95% of women in G1 were positive for HR-HPV others than 16/18 (notably HPV-52). The percentage of high-grade cervical cytology was 6%, 9%, and 7% with a rate of cytohistological discrepancy of 14%, 16%, and 11%, in G1, G2, and G3 respectively. By evaluating potential risk factors for these findings, infection by HPV-18 showed statistical significance (p=0,036), with an odds ratio (OR) of 6,7 in G1. In G3, smoking habits (p=0,009), previous cervix interventions (p=0,03), and infection by HPV-16 were found as potential risk factors for cytohistological discrepancy, with an OR of 5.5, 4.8, and 3.5, respectively. No statistically significant results were found for women in G2.

Conclusion

In conclusion, these findings highlight the importance of age and the role of HPV genotyping in assessing the risk of cervical abnormalities. Our data suggest an increased surveillance could be considered regarding individual risk factors and HPV genotype.