Risk of high-grade cervical intraepithelial neoplasia among young women with abnormal screening cytology

Objective. To estimate the risk of high-grade cervical disease among teenage women with abnormal cytology. Methods. Retrospective analysis of a prospectively collected database of females undergoing colposcopy for abnormal screening cytology in an urban dysplasia clinic. Results. Among 211 eligible teens, high-grade squamous intraepithelial lesions were found in 17 (8%) on referral cytology and 4 (2%) on repeat cytology. High-grade cervical intraepithelial neoplasia was found in colposcopic biopsy specimens 30 (15%) of young women; no patient had cancer. Age, referral Pap, ethnicity, parity, HIV serostatus, history of other sexually transmitted infections, smoking, oral contraceptive use condom use, use of medroxyprogesterone, age at first intercourse, and the number of years since first intercourse did not predict increasing risk of high-grade cervical intraepithelial neoplasia (CIN). In logistic regression, both number of partners ≥ 5 (p = 0.003) and a finding of any squamous intraepithelial lesion in a Pap test repeated at colposcopy (p = 0.025) were significant predictors of CIN 2,3, though the predictive value of the model was weak (R² = 0.12). Conclusion. Only 15% of teens with abnormal cytology have high-grade CIN. Colposcopy may be most appropriate for those with multiple partners and squamous intraepithelial lesions on repeat Pap.