A Study of Histopathologic Outcomes of Women With Cryotherapy-Ineligible lesions on Cervicography

Objectives To determine the association between high grade cervical intraepithelial neoplasia (CIN 2+) and individual acetowhite cryotherapy-ineligible lesion types, as determined by cervicography.Design: a cross sectional study Setting: Gynecologic Cancer Prevention Unit of the University Teaching Hospital, Zambia.Population: Women referred to the study site for histologic evaluation of cryotherapy-ineligible lesions of the cervix were included in the study.Individual acetowhite lesion types which do not meet criteria for cryotherapy include those that (1)cover more than 75% of the transformation zone, (2) disappear into the endocervical canal, (3) contain abnormal vasculature (mosaicism, punctuations, or atypical blood vessels), and (4) are thick.Main outcome measures: Histologic diagnosis of high grade cervical intraepithelial neoplasia (CIN 2+) for each cryotherapy-ineligible acetowhite lesion type of the cervix.Results: A total of 130 women were enrolled into the study. Women with lesions occupying greater than 75% of the transformation zone had five fold greater odds of CIN 2+ than women with other lesions, OR 4.5 (95% CI 2.19.9), p < 0.001. Women with thick acetowhite lesions were less likely to have CIN 2+, OR 1.1 (95% CI 0.4 3.0), p=0.84. Women with lesions disappearing into the endocervix beyond complete visualization were far less likely to have CIN 2+, OR 0.1 (95% CI 0.040.45), p< 0.001. No association was detected between CIN 2+ and lesions with abnormal vessels. After multivariable adjustment, there remained a significant association between lesions covering greater than 75% of the transformation zone and CIN 2+, OR 2.2 (95% CI 1.43.4). However, other individual cryotherapy-ineligible acetowhite lesion types were no longer associated with CIN 2+.
Conclusions: Cryotherapy-ineligible acetowhite lesions occupying greater than 75% of the transformation zone diagnosed on cervicography are associated with histopathologic outcome of high grade cervical intraepithelial neoplasia.