Management of low-grade cervical cytology in young women. Cohort study from Denmark

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  • Gry St-Martin, University of Copenhagen
  • ,
  • Lise Holst Thamsborg, University of Copenhagen
  • ,
  • Berit Andersen
  • Jette Christensen, Aalborg University
  • ,
  • Dorthe Ejersbo, University of Southern Denmark
  • ,
  • Kirsten Jochumsen, University of Southern Denmark
  • ,
  • Tonje Johansen
  • ,
  • Lise Grupe Larsen, Zealand University Hospital
  • ,
  • Marianne Waldstrøm, University of Southern Denmark
  • ,
  • Elsebeth Lynge, University of Copenhagen

Objective: Cytology findings of atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) are common among women under 30, but evidence on best management strategy is insufficient. We therefore investigated how different management strategies used in Denmark influenced biopsy rates and detection of cervical intraepithelial neoplasia (CIN). Methods: Register-based cohort study including Danish women aged less than 30 years and born 1980–95, with ASCUS/LSIL as their first abnormal cervical cytology in 2008–16. Rates and relative risks (RR) of biopsy and detection of CIN3+, CIN2 and < CIN2 during two years follow-up were compared between women referred directly to colposcopy after ASCUS/LSIL or undergoing additional testing, including mRNA or DNA test for high risk HPV or repeat cytology. Results: 19,946 women with ASCUS and 19,825 with LSIL were included in the study of whom 92% had adequate information about follow-up. Among women referred directly to biopsy, CIN3+ was detected among 21%, CIN2 in 17%, while 62% had < CIN2. Repeating cytology after 6 months reduced the biopsy rate to 44% of which 53% had < CIN2. Biopsy rates with HPV test were 67% for DNA test, 77% with 14-type mRNA test and 58% with 5-type mRNA test. The detection of CIN3+ was somewhat higher, between 13% and 14% for the three HPV tests vs. 11% with repeat cytology. However, the detection of < CIN2 (not indicating treatment) also increased with RR 2.11 (95% CI 2.01–2.21) for 14-type mRNA test, 1.35 (95% CI 1.29–1.41) for 5-type mRNA test, and 1.86 (95% CI 1.76–1.97) with HPV DNA test. Conclusions: The choice of management strategy influences both the detection rate for severe lesions (CIN3+) and the proportion of women followed up for potentially insignificant findings.

Original languageEnglish
JournalActa Oncologica
Volume60
Issue4
Pages (from-to)444-451
Number of pages8
ISSN0284-186X
DOIs
Publication statusPublished - Apr 2021

    Research areas

  • ASCUS, Cervical cancer screening, LSIL

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