Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

Objective: The aim of this study was to describe the evolution of high-grade cervical dysplasia during pregnancy and the postpartum period and to determine factors associated with dysplasia regression. Methods: Pregnant patients diagnosed with high-grade lesions were identified in our tertiary hospi...

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Autores principales:	Yvan Gomez, Vincent Balaya, Karine Lepigeon, Patrice Mathevet, Martine Jacot-Guillarmod
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	high-grade dysplasia cervical cancer cervical intraepithelial neoplasia CIN HSIL ASC-H Medicine R
Acceso en línea:	https://doaj.org/article/2b9821c9a3914d99b941fdcb3a8c7976
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spelling	oai:doaj.org-article:2b9821c9a3914d99b941fdcb3a8c79762021-11-25T18:01:39ZPredictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy10.3390/jcm102253192077-0383https://doaj.org/article/2b9821c9a3914d99b941fdcb3a8c79762021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5319https://doaj.org/toc/2077-0383Objective: The aim of this study was to describe the evolution of high-grade cervical dysplasia during pregnancy and the postpartum period and to determine factors associated with dysplasia regression. Methods: Pregnant patients diagnosed with high-grade lesions were identified in our tertiary hospital center. High-grade lesions were defined either cytologically, by high squamous intraepithelial lesion/atypical squamous cells being unable to exclude HSIL (HSIL/ASC-H), or histologically, with cervical intraepithelial neoplasia (CIN) 2+ (all CIN 2 and CIN 3) during pregnancy. Postpartum regression was defined cytologically or histologically by at least a one-degree reduction in severity from the antepartum diagnosis. A logistic regression model was applied to determine independent predictive factors for high-grade cervical dysplasia regression after delivery. Results: Between January 2000 and October 2017, 79 patients fulfilled the inclusion criteria and were analyzed. High-grade cervical lesions were diagnosed by cytology in 87% of cases (69/79) and confirmed by histology in 45% of those (31/69). The overall regression rate in our cohort was 43% (34/79). Univariate analysis revealed that parity (<i>p</i> = 0.04), diabetes (<i>p</i> = 0.04) and third trimester cytology (<i>p</i> = 0.009) were associated with dysplasia regression. Nulliparity (OR = 4.35; 95%CI = (1.03–18.42); <i>p</i>= 0.046) was identified by multivariate analysis as an independent predictive factor of high-grade dysplasia regression. The presence of HSIL on third-trimester cervical cytology (OR = 0.17; 95%CI = (0.04–0.72); <i>p</i> = 0.016) was identified as an independent predictive factor of high-grade dysplasia persistence at postpartum. Conclusion: Our regression rate was high, at 43%, for high-grade cervical lesions postpartum. Parity status may have an impact on dysplasia regression during pregnancy. A cervical cytology should be performed at the third trimester to identify patients at risk of CIN persistence after delivery. However, larger cohorts are required to confirm these results.Yvan GomezVincent BalayaKarine LepigeonPatrice MathevetMartine Jacot-GuillarmodMDPI AGarticlehigh-grade dysplasiacervical cancercervical intraepithelial neoplasiaCINHSILASC-HMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5319, p 5319 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	high-grade dysplasia cervical cancer cervical intraepithelial neoplasia CIN HSIL ASC-H Medicine R
spellingShingle	high-grade dysplasia cervical cancer cervical intraepithelial neoplasia CIN HSIL ASC-H Medicine R Yvan Gomez Vincent Balaya Karine Lepigeon Patrice Mathevet Martine Jacot-Guillarmod Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy
description	Objective: The aim of this study was to describe the evolution of high-grade cervical dysplasia during pregnancy and the postpartum period and to determine factors associated with dysplasia regression. Methods: Pregnant patients diagnosed with high-grade lesions were identified in our tertiary hospital center. High-grade lesions were defined either cytologically, by high squamous intraepithelial lesion/atypical squamous cells being unable to exclude HSIL (HSIL/ASC-H), or histologically, with cervical intraepithelial neoplasia (CIN) 2+ (all CIN 2 and CIN 3) during pregnancy. Postpartum regression was defined cytologically or histologically by at least a one-degree reduction in severity from the antepartum diagnosis. A logistic regression model was applied to determine independent predictive factors for high-grade cervical dysplasia regression after delivery. Results: Between January 2000 and October 2017, 79 patients fulfilled the inclusion criteria and were analyzed. High-grade cervical lesions were diagnosed by cytology in 87% of cases (69/79) and confirmed by histology in 45% of those (31/69). The overall regression rate in our cohort was 43% (34/79). Univariate analysis revealed that parity (<i>p</i> = 0.04), diabetes (<i>p</i> = 0.04) and third trimester cytology (<i>p</i> = 0.009) were associated with dysplasia regression. Nulliparity (OR = 4.35; 95%CI = (1.03–18.42); <i>p</i>= 0.046) was identified by multivariate analysis as an independent predictive factor of high-grade dysplasia regression. The presence of HSIL on third-trimester cervical cytology (OR = 0.17; 95%CI = (0.04–0.72); <i>p</i> = 0.016) was identified as an independent predictive factor of high-grade dysplasia persistence at postpartum. Conclusion: Our regression rate was high, at 43%, for high-grade cervical lesions postpartum. Parity status may have an impact on dysplasia regression during pregnancy. A cervical cytology should be performed at the third trimester to identify patients at risk of CIN persistence after delivery. However, larger cohorts are required to confirm these results.
format	article
author	Yvan Gomez Vincent Balaya Karine Lepigeon Patrice Mathevet Martine Jacot-Guillarmod
author_facet	Yvan Gomez Vincent Balaya Karine Lepigeon Patrice Mathevet Martine Jacot-Guillarmod
author_sort	Yvan Gomez
title	Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy
title_short	Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy
title_full	Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy
title_fullStr	Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy
title_full_unstemmed	Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy
title_sort	predictive factors involved in postpartum regressions of cytological/histological cervical high-grade dysplasia diagnosed during pregnancy
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/2b9821c9a3914d99b941fdcb3a8c7976
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Predictive Factors Involved in Postpartum Regressions of Cytological/Histological Cervical High-Grade Dysplasia Diagnosed during Pregnancy

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