Risk factors of histologic upgrade between colposcopy-directed biopsy and loop electrosurgical excision procedure in cervical squamous intraepithelial lesions: A retrospective study

Yuan Ma¹Bowen Xu^2,3Tingting Zhang²Yong Zhi¹Heling Ma¹Yuanbo Ling¹Jie Xu¹Liyan Sun^4*Fang Li^1*

• ¹Department of Gynecology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
• ²Department of Gynecology, Shanghai University of Traditional Chinese Medicine Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China
• ³Department of Traditional Chinese Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
• ⁴Department of Gynecology, Shanghai Pudong New Area People's Hospital, Shanghai, China

Background: The aim of this study is to compare the pathological outcomes between colposcopy-directed biopsy (CDB) and loop electrosurgical excision procedure (LEEP) in patients diagnosed with cervical squamous intraepithelial lesions (SIL), and to evaluate the risk factors correlated with histologic upgrade from CDB to subsequent LEEP conization. Methods: This retrospective study included a total of 1496 patients who underwent LEEP after receiving pathological confirmation of cervical SIL through CDB. Statistical analysis was employed to assess the risk factors associated with the histologic upgrade of biopsy. Results: The study cohort was composed of 410 patients initially categorized with LSIL and 1086 identified with HSIL, who subsequently underwent LEEP surgery. Among the LSIL-patients diagnosed via CDB, 79 showed instances of biopsy histologic upgrade. The analysis revealed that HPV16 (P<0.001, OR 95% CI [1.58,5.02]), HPV18 (P<0.001, OR 95%CI [2.11,9.29]), and type of cervical transformation zone (P<0.001) were substantial risk factors leading to histologic upgrade in patients identified with LSIL by CDB. Out of the 1086 patients who received pathological confirmation of HSIL through CDB, 19 were additionally diagnosed with cervical cancer. Among the upgraded patients, none represented type 1 cervical transformation zone. Furthermore, type 3 transformation zone was notably more susceptible to histologic upgrade compared to type 2 transformation zone (χ2 =8.83, P=0.003). Univariate analysis revealed HPV16 (P=0.049, OR 95%CI [1.00,6.58]) and HPV18 infection (P<0.001, OR 95% CI [2.50,18.40]) were significant contributors to the histologic upgrade of HSIL. Conclusions: Our study identified that HPV16/18 infection and a non-fully visible cervical transformation zone are significant risk factors associated with histologic upgrade between CDB and subsequent LEEP conization.