A retrospective study comparing the efficiency of recurrent LSIL cytology to high-grade cytology as predictors of high-grade cervical intraepithelial neoplasia or worse (CIN2+)

Figures & data

Table 1: Total number of women with recurrent LSIL cytology, HSIL and with histologically confirmed CIN2+

Cytology	Number of women	Number of women with CIN2+	PPV (%)	(95% CI)
LSIL	172	54	33.75	(28.54–39.39)
HSIL	172	144	83.72	(78.54–87.85)

PPV = positive predictive value.

Table 2: Overall sensitivity, specificity, and diagnostic accuracy of HSIL cytology to detect CIN2+ incidence among 344 women

HSIL cytology
Histopathology result
		CIN2+	<CIN2+	Total
Referral	HSIL	144	28	172
	LSIL	54	106	160
	Total	198	134	332
Validity of HSIL cytology to act as a predictor of CIN2+
		(95% CI)
Sensitivity	72.73	(65.96–78.80)
Specificity	79.10	(71.24–85.64)
PPV	83.72	(78.54–87.85)
NPV	66.25	(60.61–71.46)

LSIL = low-grade squamous intraepithelial lesions.

HSIL = high-grade squamous intraepithelial lesions.

<CIN2 =women with cervical intraepithelial neoplasia (CIN) 1 or normal.

CIN2+ = women with CIN2, CIN3 and cervical cancer (CC).

PPV = positive predictive value, NPV = negative predictive value.

Table 3: Overall sensitivity, specificity, and diagnostic accuracy of recurrent LSIL cytology to detect CIN2+ incidence among 344 women

LSIL cytology
Histopathology result
		CIN2+	<CIN2+	Total
Referral cytology	LSIL	54	106	160
	HSIL	144	28	172
	Total	198	134	332
Validity of recurrent LSIL cytology to act as a predictor of CIN2+
		(95% CI)
Sensitivity	27.27	(21.20–34.04)
Specificity	19.18	(14.36–28.76)
PPV	33.75	(28.54–39.39)
NPV	16.28	(12.15–21.46)

LSIL = low-grade squamous intraepithelial lesions.

HSIL = high-grade squamous intraepithelial lesions.

<CIN2 =women with cervical intraepithelial neoplasia (CIN) 1 or normal.

CIN2+ = women with CIN2, CIN3 and cervical cancer (CC).

PPV = positive predictive value, NPV = negative predictive value.

Table 4: Association between demographic factors and the outcome, CIN2+

Outcome, n (%)
Predictor	<CIN2+	CIN2+	p-value
Age:	n = 146	n = 198	0.193^1
20–29	21 (14.38)	18 (9.09)
30–39	59 (40.41)	94 (47.47)
40–49	54 (36.99)	61 (30.81)
50–59	8 (5.48)	20 (10.10)
60–69	2 (1.37)	4 (2.02)
70+	2 (1.37)	1 (0.51)
HIV status:	n = 145	n = 196	0.012^2
Positive	111 (76.55)	125 (63.78)
Negative	34 (23.45)	71 (36.22)
CD4+ count:	n = 96	n = 96	0.461^2
<100	13 (13.54)	10 (10.42)
100–199	8 (8.33)	14 (14.58)
200–349	24 (25.00)	27 (28.13)
350+	51 (53.13)	45 (56.88)
ARV treatment:	n = 110	n = 121	0.015^1
Yes	100 (90.91)	119 (98.35)
No	10 (9.09)	2 (1.65)
Viral load:	n = 101	n = 112	0.938^2
<20	64 (63.37)	71 (63.39)
20–99	20 (19.80)	25 (22.32)
100–999	8 (7.92)	8 (7.14)
1 000+	9 (8.91)	8 (7.14)
Smoking status:	n = 140	n = 183	0.066^2
Smoker	26 (18.57)	50 (27.32)
Non-smoker	114 (81.43)	133 (72.68)
Multiparity:	n = 145	n = 197	0.850^2
Yes	95 (65.52)	131 (66.50)
No	50 (34.48)	66 (33.50)
Contraception use:	n = 141	n = 184	0.296^2
Yes	96 (68.09)	115 (62.50)
No	45 (31.91)	69 (37.50)

<CIN2 = women with cervical intraepithelial neoplasia (CIN) 1 or normal.

CIN2+ = women with CIN2, CIN3 and cervical cancer (CC).

¹ Fisher’s exact, ²Pearson’s chi-square.

Table 5: Log-binomial regression analysis to predict CIN2+

	Crude RR		Adjusted RR
Predictor	(95% CI)	p-value	(95% CI)	p-value
Cytology (reference: LSIL):
HSIL	2.67 (2.12–3.36)	< 0.001	2.68 (2.09–3.43)	< 0.001
HIV Status (reference: negative):
Positive	–	–	0.95 (0.82–1.10)	0.490
Smoking (reference: non-smoker):
Smoker	–	–	0.98 (0.84–1.16)	0.850
Multiparity (reference: no):
Yes	–	–	0.99 (0.80–1.16)	0.903
Contraception use (reference: no):
Yes	–	–	1.01 (0.87–1.17)	0.867

RR = risk ratio.

Table A1: Baseline demographic and clinical characteristics of patients by cytology group

	Cytology, n (%)
Characteristic	LSIL	HSIL	Total
Age:
20–29	24 (61.5)	15 (38.5)	39
30–39	80 (52.3)	73 (47.7)	153
40–49	56 (48.7)	59 (51.3)	115
50–59	9 (32.1)	19 (67.9)	28
60–69	1 (16.7)	5 (83.3)	6
70+	2 (66.7)	1 (33.3)	3
Type of biopsy:
Punch biopsy	107 (89.9)	12 (10.1)	119
Cone biopsy	6 (66.7)	3 (33.3)	9
LLETZ/LEEP	47 (23.0)	157 (77.0)	204
None	12 (100)	0 (0)	12
Biopsy result:
Positive	146 (47.1)	164 (52.9)	310
Negative	26 (76.5)	8 (23.5)	34
Lesion type:
Normal	30 (75.0)	10 (25.0)	40
CIN 1	88 (83.0)	18 (17.0)	106
CIN 2/3	53 (27.5)	140 (72.5)	193
CC	1 (20.0)	4 (80.0)	5
Prescribed treatment:
None	120 (90.2)	13 (9.8)	133
LLETZ/LEEP	51 (25.0)	153 (75.0)	204
Cold knife	0 (0)	2 (100)	2
Further Ca treatment	1 (20.0)	4 (80.0)	5
HIV status:	n = 172	n = 169	n = 341
Positive	125 (53.0)	111 (47.0)	236
Negative	47 (44.8)	58 (55.2)	105
Smoking status:	n = 166	n = 157	n = 323
Smoker	30 (39.5)	46 (60.5)	76
Non-smoker	136 (55.1)	111 (44.9)	247
Multiparity:	n = 171	n = 171	n = 342
Positive	103 (45.6)	123 (54.4)	226
Negative	68 (58.6)	48 (41.4)	116
Contraception use:	n = 166	n = 166	n = 332
Yes	116 (55.0)	95 (45.0)	211
No	49 (43.0)	65 (57.0)	114
Menopause	1 (14.3)	6 (85.7)	7

LSIL = low-grade squamous intraepithelial lesion; HSIL = high-grade squamous intraepithelial lesion.

LLETZ/LEEP = large loop excision of the transformation zone/loop electro-surgical excision procedure.

Table A2: Types of contraception utilised by each cytology group

Types of contraception	Cytology, n (%)
	LSIL	HSIL	Total
Oral	4 (36)	7 (64)	11
Injectables	73 (57)	55 (43)	128
IUCD	9 (56)	7 (44)	16
Barrier	6 (35)	11 (65)	17
Implants	0 (0)	2 (100)	2
Tubal ligation	11 (58)	8 (42)	19
Oral + barrier method	0 (0)	2 (100)	2
Injectables + barrier method	8 (80)	2 (20)	10
Implants + barrier method	0 (0)	1 (100)	1
Barrier + tubal ligation	1 (100)	0 (0)	1
Menopause	0 (0)	6 (100)	6
Not applicable/no contraception use	6 (50)	6 (50)	12
Unknown use or disuse	54 (45)	65 (55)	119

IUCD = Intrauterine contraceptive device

Table A3: Distribution of HSIL and LSIL patients according to colposcopy observations

	Crude RR		Adjusted RR
Predictor	(95% CI)	p-value	(95% CI)	p-value
Cytology (reference: LSIL):
HSIL	2.67 (2.12–3.36)	< 0.001	2.68 (2.09–3.43)	< 0.001
HIV status (reference: negative):
Positive	0.78 (0.66–0.94)	0.007	0.95 (0.82–1.10)	0.490
Smoking (reference: non-smoker):
Smoker	1.22 (1.00–1.49)	0.049	0.98 (0.84–1.16)	0.850
Multiparity (reference: no):
Yes	1.02 (0.84–1.24)	0.851	0.99 (0.85–1.16)	0.903
Contraception use (reference: no):
Yes	0.90 (0.74–1.09)	0.287	1.01 (0.87–1.17)	0.867
Age (reference: 20–29):
30–39	1.33 (0.90–1.91)	0.121	–	–
40–49	1.15 (0.79–1.68)	0.473	–	–
50–59	1.55 (1.02–2.34)	0.038	–	–
60–69	1.44 (0.75–2.79)	0.275	–	–
70+	0.72 (0.14–3.71)	0.697	–	–

RR = risk ratio.

Table A4: Log binomial regression to predict CIN2+ incidence

Colposcopy diagnosis	Cytology, n (%)
	LSIL	HSIL	Total
Aceto	87 (51)	83 (49)	170
None	42 (71)	17 (29)	59
Ace/Pun	16 (39)	25 (61)	41
Ace/Mos	9 (69)	4 (31)	13
Ace/ABN	4 (36)	7 (64)	11
Ace/Mos/Punc	3 (33)	6 (67)	9
Ace/Pun/ABN	0 (0)	7 (100)	7
Ace/Warty	5 (83)	1 (17)	6
Ace/Leuk/Punc/ABN	3 (100)	0 (0)	3
Ace/Leuko	1 (33)	2 (67)	3
Ace/Mos/ABN	0 (0)	3 (100)	3
Ace/Met/Pun	1 (50)	1 (50)	2
Ace/Leuko/ABN	0 (0)	2 (100)	2
Mos/Pun/ABN	0 (0)	2 (100)	2
Ace/Mos/Pun/ABN	0 (0)	2 (100)	2
Ace/Pun/Warty	1 (100)	0 (0)	1
Ace/Pun/ABN/Warty	0 (0)	1 (100)	1
Ace/Met/ABN	0 (0)	1 (100)	1
Ace/Met	0 (0)	1 (100)	1
Mos/Pun	0 (0)	1 (100)	1
O Warty	0 (0)	1 (100)	1
O Punctation	0 (0)	1 (100)	1
O Mosaicism	0 (0)	1 (100)	1
Leuk/Mos/Pun/ABN	0 (0)	1 (100)	1
Ace/Pun/ABN/Warty	0 (0)	1 (100)	1

Ace = Aceto White

Mos = Mosaicism

Punc/Pun = Punctuation

Met = Metaplasia

ABN = Abnormal Blood Vessels

Warty = Warty Atypia

Leuk/Leuko = Leukoplakia

O Warty = Only Warty Atypia

O Punctation = Only Punctuation

O Mosaicism= Only Mosaicism