Teoria virginia henderson

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Risk of High-Grade Cervical Intraepithelial Neoplasia among Young Women with Abnormal Screening Cytology
Stewart L. Massad, MD,1 Stephen Markwell,2 Helen E. Cejtin, MD,3 and Yvonne Collins, MD4
Department of Obstetrics and Gynecology and 2Division of Statistics and Research Consulting, the Southern Illinois University School of Medicine, Springfield; 3Department of Obstetrics and Gynecology,John Stroger Hospital, Chicago, IL; and 4Department of Obstetrics and Gynecology University of Illinois, Chicago, IL

j Abstract Objective. To estimate the risk of high-grade cervical disease among teenage women with abnormal cytology. Methods. Retrospective analysis of a prospectively collected database of females undergoing colposcopy for abnormal screening cytology in an urban dysplasiaclinic. Results. Among 211 eligible teens, high-grade squamous intraepithelial lesions were found in 17 (8%) on referral cytology and 4 (2%) on repeat cytology. High-grade cervical intraepithelial neoplasia was found in colposcopic biopsy specimens 30 (15%) of young women; no patient had cancer. Age, referral Pap, ethnicity, parity, HIV serostatus, history of other sexually transmitted infections,smoking, oral contraceptive use condom use, use of medroxyprogesterone, age at first intercourse, and the number of years since first intercourse did not predict increasing risk of high-grade cervical intraepithelial neoplasia (CIN). In logistic regression, both number of partners $ 5 (p = 0.003) and a finding of any squamous intraepithelial lesion in a Pap test repeated at colposcopy (p = 0.025)were significant predictors of CIN 2,3, though the predictive value of the model was weak (R2 = 0.12). Conclusion. Only 15% of teens with abnormal cytology have high-grade CIN. Colposcopy may be most appropriate

for those with multiple partners and squamous intraepithelial lesions on repeat Pap. j Key Words: adolescent, colposcopy, cytology, Pap test, cervical intraepithelial neoplasia

Reprintrequests to: Dr. Massad, Department of Obstetrics and Gynecology, The Southern Illinois University School of Medicine, P.O. Box 19640, Springfield, IL 62794. E-mail: smassad@siumed.edu

Ó 2005, American Society for Colposcopy and Cervical Pathology Journal of Lower Genital Tract Disease, Volume 9, Number 4, 2005, 225–229

everal authors have shown that the risk of highgrade cervicalintraepithelial neoplasia (CIN) is substantial among females with abnormal cervical cytology, ranging from 8% to 50% [1–5]. However, few of these articles stratified risk by age or by the grade of referral cytology using terminology from the Bethesda system for classification. Subsequent studies have deepened our understanding of the natural history of infection with human papillomavirus (HPV) and its rolein the development of preinvasive cervical disease. Most young women with abnormal cytology and CIN 1 and some with CIN 2 may have transient HPV infections of minimal clinical significance, though lifetime risk for cervical cancer may still be increased [6, 7]. One recent article has suggested that young women with cytologic findings indicating low-grade squamous intraepithelial lesions (SIL) canbe followed without colposcopic evaluation to rule out high-grade CIN, because most will resolve without treatment, though that study was flawed by


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excluding women with CIN 2 or 3 at intake colposcopy [8]. To better understand the likelihood of high-grade CIN in young women with abnormal cytology, we analyzed a prospectively collected database of patientsreferred for colposcopy to the Dysplasia Clinic at Cook County Hospital.

The methods used to develop the database for the study have been previously described [9]. Briefly, colposcopy was performed and data gathered prospectively for females attending the Cook County Hospital Dysplasia Clinic, a colposcopy referral center for indigent women in metropolitan Chicago, between...