Risk of cervical precancer and cancer in women with cervical intraepithelial neoplasia grade 1 on endocervical curettage.

OBJECTIVE: This study aimed to characterize the 24-month risk of cervical intraepithelial neoplasia grade 2 or worse (CIN 2+) and grade 3 or worse (CIN 3+) in women with low-risk cytological finding and CIN 1 on endocervical curettage (ECC). MATERIALS AND METHODS: Cervical screening tests and cervical biopsy results from Kaiser Permanente Northern California were reviewed for years 2004 to 2008. Women with index cytological result of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion who underwent excisional procedure within 24 months of CIN 1 diagnosis were grouped by ECC status. A third cohort comprised women with ECC-CIN 1 followed up without excisional procedure. The 24-month cumulative incidence of CIN 2+ and CIN 3+ was calculated for each cohort. RESULTS: Excisional procedures were performed in 224 women; 54 had ECC-CIN 1 with ectocervical biopsy CIN 1 or less, and 170 had ectocervical CIN 1 with negative ECC finding. The 24-month risk of CIN 2+ was lower in the ECC-CIN 1 cohort compared with the ECC-negative (ectocervical CIN 1) cohort (24.1 vs 44.7%, p = .018) and nonsignificantly lower for CIN 3+ (7.4% vs 14.1%, p = .23). Among 203 women with ECC-CIN 1 followed up without excisional procedure but with follow-up ECC at a median of 21.7 months from index ECC, CIN 2 was found in 21 (10.3%, 95% CI = 6.7%-15.6%), and CIN 3 was found in 3 (1.5%, 95% CI = 0.4%-4.6%). CONCLUSIONS: A diagnosis of CIN 1 on ECC preceded by atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion does not increase the risk of CIN 2+ compared with women with ectocervical CIN 1 and negative ECC. The risk of CIN 2+ in women followed up without excisional procedure is sufficiently low that it is reasonable to offer conservative management similar to that for ectocervical CIN 1.

Calculation of gestational age in late second and third trimesters by ex vivo magnetic resonance spectroscopy of amniotic fluid.

OBJECTIVE: The purpose of this study was to develop a reliable model for the calculation of gestational age (GA) in second and third trimesters with the use of amniotic fluid (AF) metabolite profiles that were determined by magnetic resonance spectroscopy. STUDY DESIGN: High-resolution (11.7 T) ex vivo magnetic resonance spectroscopy was performed on 95 AF samples (mean, 31.7 weeks; range, 15.6-39.9 weeks). GA was determined by last menstrual period or first-trimester ultrasound scanning. Concentrations of 21 AF metabolites were measured with automated techniques. Metabolite concentrations, inverses, natural logs, and squares were entered as predictive variables in a stepwise linear regression model. RESULTS: The following formula was derived: GA = 64.922 - (14.456 x alanine) + (4.965 x natural log [creatinine]) - (0.931 x glucose) - (5.202 x valine). This model fit the data with an R(2) value of 0.926. Average error among all samples was +/-1.75 weeks (SD, +/-1.43 weeks), for the second trimester was +/-2.21 weeks (SD, +/-1.78 weeks), and for the third trimester was +/-1.59 weeks (SD, +/-1.26 weeks). CONCLUSION: Statistical modeling accurately predicted GA with amniotic fluid metabolite profiles that were obtained by magnetic resonance spectroscopy, which may represent a significant improvement over conventional ultrasound dating in the third trimester. Future studies should compare these techniques directly.

Cervical human papillomavirus incidence and persistence in a cohort of HIV-negative women in Zimbabwe.

BACKGROUND: Persistent infections with oncogenic human papillomavirus (HPV) types are causally related to cervical cancer. Little is known about the distribution of HPV types, independent risk factors of incidence and persistence, and patterns of persistence in sub-Saharan Africa. METHODS: A cohort of 2040 Zimbabwean women was enrolled in a randomized trial assessing the effect of diaphragm/gel provision on human immunodeficiency virus and HPV acquisition. Data from the study arms were pooled for this analysis because diaphragm/gel provision did not affect HPV acquisition and clearance. Clinicians collected cervical samples for HPV testing at enrollment, 12 months, and exit (median 21 months). RESULTS: HPV prevalence was 24.5% for any HPV type and 16.1% for oncogenic types. HPV incidence at 12 months was 23.3% for any HPV type and 11.4% for oncogenic types. HPV58 had the highest baseline prevalence (5.0%) and incidence (2.4%). Type-specific persistence was 29.8% among all HPV infections over a median of 21 months of follow-up. Baseline predictors of incident HPV infection were younger age, having more than 1 lifetime sexual partner, infrequent condom use, herpes simplex virus-2 positive serology, and having a sexually transmissible infection or a different HPV type at enrollment. Baseline predictors of persistent HPV infection were younger age, having more than 1 lifetime sexual partner, and having a high-risk partner. CONCLUSIONS: The novel association between herpes simplex virus-2 seropositivity and incident HPV infection warrants further investigation. Having a high-risk partner is a potentially modifiable risk factor for persistent HPV infection. The relatively high prevalence of HPV58 has implications for vaccine development.