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Clinical outcome of high-grade cervical intraepithelial neoplasia during pregnancy: A 10-year experience

  • Author Footnotes
    1 Da Kyung Hong and Seon Ah Kim contributed equally to this work.
    Da Kyung Hong
    Footnotes
    1 Da Kyung Hong and Seon Ah Kim contributed equally to this work.
    Affiliations
    Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea

    Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
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  • Author Footnotes
    1 Da Kyung Hong and Seon Ah Kim contributed equally to this work.
    Seon Ah Kim
    Footnotes
    1 Da Kyung Hong and Seon Ah Kim contributed equally to this work.
    Affiliations
    Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Kyung Taek Lim
    Affiliations
    Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea

    Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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  • Ki Heon Lee
    Affiliations
    Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea

    Department of Obstetrics & Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
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  • Tae Jin Kim
    Affiliations
    Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea
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  • Kyeong A So
    Correspondence
    Corresponding author at: Department of Obstetrics and Gynecology, Konkuk University School of Medicine, 120-1, Neungdong-ro, Gwangjin-gu, Seoul 05030, Republic of Korea.
    Affiliations
    Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    1 Da Kyung Hong and Seon Ah Kim contributed equally to this work.

      Abstract

      Objective

      To investigate the clinical outcome of high-grade cervical intraepithelial neoplasia (CIN) diagnosed by colposcopy-directed biopsy during pregnancy and to evaluate the risk factors for persistent disease.

      Study Design

      This retrospective study included pregnant women who were diagnosed with CIN2+ by colposcopy-directed biopsy from January 2005 to December 2014. The clinical characteristics, histopathologic results, and human papillomavirus (HPV) test results were reviewed. The final histopathologic result after delivery was compared with the initial diagnosis to determine disease progression, persistence, or regression.

      Results

      During the 10-year period, 215 pregnant women were diagnosed with high-grade CIN (75 CIN2, 140 CIN3) by colposcopy-directed biopsy. The mean age of the patients was 30.4 years. A total of 187 patients (87.0%) had high-risk HPV infections, with 76 (35.3%) infections identified as HPV genotype 16 or 18. Excisional procedures for diagnosis and treatment were not performed during pregnancy. The histopathologic results of 160 patients (normal in 43, CIN1 in 10, CIN2 in 15, CIN3 in 89, and invasive cancer in 3) were evaluated during the postpartum period. Multivariate logistic regression analysis was performed, and postpartum high-risk HPV infection (OR 5.09; 95% CI 2.15–12.05; P < 0.001) was identified as a significant independent predictor of CIN2+ persistence.

      Conclusions

      Conservative management of CIN2-3 during pregnancy is acceptable. However, persistent high-risk HPV infection is a major risk factor for CIN2+ persistence. Close follow-up with HPV testing, and postpartum colposcopy evaluation are necessary.

      Keywords

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      References

        • McIntyre-Seltman K.
        • Lesnock J.L.
        Cervical Cancer screening in pregnancy.
        Obstet Gynecol Clin N Am. 2008; 35: 645-658
        • Insinga R.P.
        • Glass A.G.
        • Rush B.B.
        Diagnoses and outcomes in cervical cancer screening: a population-based study.
        Am J Obstet Gynecol. 2004; 191: 105-113
        • Owens G.L.
        • Kitchener H.C.
        Premalignant disease in the genital tract in pregnancy.
        Best Pract Res Clin Obstet Gynaecol. 2016; 33: 33-43
        • Hunter M.I.
        • Monk B.J.
        • Tewari K.S.
        Cervical neoplasia in pregnancy. Part 1: screening and management of preinvasive disease.
        Am J Obstet Gynecol. 2008; 199: 3-9
        • Freeman-Wang T.
        • Walker P.
        Colposcopy in special circumstances: Pregnancy, immunocompromise, including HIV and transplants, adolescence and menopause.
        Best Pract Res Clin Obstet Gynaecol. 2011; 25: 653-665
        • Flannelly G.
        The management of women with abnormal cervical cytology in pregnancy.
        Best Pract Res Clin Obstet Gynaecol. 2010; 24: 51-60
        • Elhassan M.E.
        • Omer A.M.
        • Ahmed A.M.
        • Badreldeen A.
        • Elhadi M.
        Cervical carcinoma in pregnancy: case report.
        Gynecol Perinatol. 2009; 18: 93-95
        • Palle C.
        • Bangsboll S.
        • Andreasson B.
        Cervical intraepithelial neoplasia in pregnancy.
        Acta Obstet Gynecol Scand. 2000; 79: 306-310
        • Massad L.S.
        • Einstein M.H.
        • Huh W.K.
        • Katki H.A.
        • Kinney W.K.
        • Schiffman M.
        • et al.
        Updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors.
        Obstet Gynecol. 2012; 2013: 829-846
        • Siddiqui G.
        • Kurzel R.B.
        • Lampley E.C.
        • Kang H.S.
        • Blankstein J.
        Cervical dysplasia in pregnancy: progression versus regression postpartum.
        Int J Fertil Womens Med. 2001; 46: 278-280
        • Fader A.N.
        • Alward E.K.
        • Niederhauser A.
        • Chirico C.
        • Lesnock J.L.
        • Zwiesler D.J.
        • et al.
        Cervical dysplasia in pregnancy: a multi-institutional evaluation.
        Am J Obstet Gynecol. 2010; 203: e1-6
        • Stonehocker J.
        Cervical cancer screening in pregnancy.
        Obstet Gynecol Clin North Am. 2013; 40: 269-282
        • Paraskevaidis E.
        • Koliopoulos G.
        • Kalantaridou S.
        • Pappa L.
        • Navrozoglou I.
        • Zikopoulos K.
        • et al.
        Management and evolution of cervical intraepithelial neoplasia during pregnancy and postpartum.
        Eur J Obstet Gynecol Reprod Biol. 2002; 104: 67-69
        • Kärrberg C.
        • Brännström M.
        • Strander B.
        • Ladfors L.
        • Rådberg T.
        Colposcopically directed cervical biopsy during pregnancy; minor surgical and obstetrical complications and high rates of persitence and regression.
        Acta Obstet Gynecol Scand. 2013; 92: 692-699
        • Frega A.
        • Scirpa P.
        • Corosu R.
        • Verrico M.
        • Scarciglia M.L.
        • Primieri M.R.
        • et al.
        Clinical management and follow-up of squamous intraepithelial cervical lesions during pregnancy and postpartum.
        Anticancer Res. 2007; 27: 2743-2746
        • Vlahos G.
        • Rodolakis A.
        • Diakomanolis E.
        • Stefanidis K.
        • Haidopoulos D.
        • Abela K.
        • et al.
        Conservative management of cervical intraepithelial neoplasia (CIN2–3) in Pregnant Women.
        Gynecol Obstet Invest. 2002; 54: 78-81
        • Coppolillo E.F.
        • Ruda D.E.
        • Vega H.M.
        • Brizuela J.
        • Eliseth M.C.
        • Barata A.
        • et al.
        High-grade cervical neoplasia during pregnancy: diagnosis, management and postpartum findings.
        Acta Obstet Gynecol Scand. 2013; 92: 293-297
        • Yost N.P.
        • Santoso J.T.
        • McIntire D.D.
        • Iliya F.A.
        Postpartum regression rates of antepartum cervical intraepithelial neoplasia II and III lesions.
        Obstet Gynecol. 1999; 93: 359-362
        • Delvenne P.
        • Herman L.
        • Kholod N.
        • Caberg J.H.
        • Herfs M.
        • Boniver J.
        • et al.
        Role of hormone cofactors in the human papillomavirus induced carcinogenesis of the uterine cervix.
        Mol Cell Endocrinol. 2007; 264: 1-5
        • Gariglio P.
        • Gutierrez J.
        • Cortes E.
        • Vazquez J.
        The role of retinoid deficiency and estrogens as cofactors in cervical cancer.
        Arch Med Res. 2009; 40: 449-465
        • Fife K.H.
        • Katz B.P.
        • Roush J.
        • Handy V.D.
        • Brown D.R.
        • Hansell R.
        Cancer-associated human papillomavirus types are selectively increased in the cervix of women in the first trimester of pregnancy.
        Am J Obstet Gynecol. 1996; 174 (1487-52)
        • Mailath-Pokorny M.
        • Schwameis R.
        • Grimm C.
        • Reinthaller A.
        • Polterauer S.
        Natural history of cervical intraepithelial neoplasia in pregnancy: postpartum histo-pathologic outcome and review of the literature.
        BMC Pregnancy Childbirth. 2016; 16: 74
        • Economos K.
        • Veridiano N.P.
        • Delke I.
        • Collado M.L.
        • Tancer M.L.
        Abnormal cervical cytology in Pregnancy: a 17-year experience.
        Obstet Gynecol. 1993; 81: 915-918
        • Živadinović R.
        • Lilić G.
        • Lilić V.
        • Đorđević B.
        • Petrić A.
        Oucome of the pregnancies after uterine cervix conization.
        Med Biol. 2007; 14: 88-91
        • Tewari K.S.
        Cancer in pregnancy.
        in: DiSaia P.J. Creasman W.T. Clinical gynecologic oncology. 9th ed. Elsevier, Philadelphia2018: 353-418
        • Amant F.
        • Brepoels L.
        • Halaska M.J.
        • Gziri M.M.
        • Calsteren K.V.
        Gynaecologic cancer complicating pregnancy: An overview.
        Best Pract Res Clin Obstet Gynaecol. 2010; 24: 61-79
        • Matsubara Y.
        • Fujioka T.
        • Hashimoto H.
        • Hamada K.
        • Matsubara K.
        • Nawa A.
        Management of cervical intraepithelial neoplasia in Japanese pregnant women.
        Open J Obstet Gyneco. 2013; 3: 337-340