engleski

Natural history of cervical squamous intraepithelial lesions

Laboratory and epidemiologic data suggest that persistent infections with carcinogenic human papillomaviruses (HPV) cause virtually all cervical cancers (CC). There are over 100 HPV types, of which more than 30 infect the genital area of women. Genital HPV infection results in a variety of outcomes. Immune response appears to be a key determinant of HPV epidemiology and oncogenicity. Studies of the natural history of CC indicate that infection with HPV may be transient (approximately 90% of HPV infections clear within two years) or can persist and cause cervical intraepithelial lesions (CIN) of a different degree. Few CIN have the potential to progress to invasive cancer. The aim of our study was to estimate squamous intraepithelial lesion (SIL) progression, persistence and regression. The current study utilized tissue from 38 patients who had SIL on a PAP test. Patients were classified based on “Zagreb 2002” classification of cytologic findings of cervix uteri. The study includes only those patients who had normal colposcopic findings and in whom endocervical curettage, if needed, did not show abnormal tissue. The patients were followed up for 3 years. The median age of patients was 36 years (range, 17 to 68 years). Low-grade SIL (LSIL) was found in 30 patients, and high-grade SIL (HSIL) was found in 8 patients. LSIL regressed in 16 (53%) patients, persisted in 12 (40%) patients and progressed to HSIL in 2 (7%) patients. HSIL regressed in 4 (50%) patients and persisted in 4 (50%) patients. We did not find progression to invasive carcinoma. The results of our study are in accordance with results reported in relevant medical journals worldwide where the approximate likelihood of regression of CIN 1 is 60%, persistence 30%, progression to CIN 3 10%, and progression to invasion 1%. The corresponding approximations for CIN 2 are 40%, 40%, 20%, and 5%, respectively. The likelihood of CIN 3 regressing is 33% and progressing to invasion greater than 12%. What determines that an individual infection will progress or not has been, and remains, the focus of numerous studies.

Cervical squamous intraepithelial lesions; Progression; Persistence; Regression

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