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A Cervical Abnormality Risk Prediction Model: Can We Use Clinical Information to Predict Which Patients With ASCUS/LSIL Pap Tests Will Develop CIN 2/3 or AIS?

Charlton, Brittany M. MSc1; Carwile, Jenny L. MPH1; Michels, Karin B. ScD, PhD1,2; Feldman, Sarah MD, MPH3

Journal of Lower Genital Tract Disease: July 2013 - Volume 17 - Issue 3 - p 242–247
doi: 10.1097/LGT.0b013e3182730fec
Original Articles

Objective Human papillomavirus (HPV) infections and abnormal Pap test results are common, and most do not progress to cervical cancer. Because it is difficult to predict which mild Pap abnormalities will develop into precancerous lesions, many women undergo painful and costly evaluations and even unnecessary treatment. The objective of this study was to develop a risk prediction model based on clinical and demographic information to identify women most likely to develop significant precancerous lesions (cervical intraepithelial neoplasia grades 2/3 [CIN 2/3] or adenocarcinoma in situ [AIS]) among women with mild Pap abnormalities (atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion).

Materials and Methods The Abnormal Pap Smear Registry includes women who received treatment at the Brigham and Women’s Hospital/Dana Farber Cancer Institute Pap Smear Evaluation Center beginning in 2006. It includes 1,072 women with mild cervical dysplasia (atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion) on their referral Pap test. We derived a clinical prediction model to predict the probability of developing CIN 2/3 or AIS using multivariate logistic regression with a split-sample approach.

Results By the end of the follow-up, 93 of the 1,072 women developed CIN 2/3 or AIS (8.7%). There were several differences between women who developed CIN 2/3 or AIS and women who did not. However, once we put these into the regression model, the only variable that was significantly associated with CIN 2/3 or AIS was having a history of an abnormal Pap or biopsy result (odds ratio = 2.44; 95% CI =1.03–5.76). The resulting prediction model had poor discriminative ability and was poorly calibrated.

Conclusions Despite accounting for known risk factors, we were unable to predict individual patients’ probability for progression on the basis of available data.

A quality risk prediction model for significant precancerous lesions (CIN 2/3 or AIS) could not be created based on clinical/demographic information among women with mild Pap abnormalities (ASCUS/LSIL).

1Department of Epidemiology, Harvard School of Public Health; 2Obstetrics and Gynecology Epidemiology Center, and 3Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, MA

Reprint requests to: Brittany M. Charlton, MSc, Department of Epidemiology, Harvard School of Public Health, 677 Huntington Ave, 9th Floor, Boston, MA 02115. E-mail:

Ms. Charlton was supported by the Training Program in Cancer Epidemiology under grant T32 CA 09001. Ms. Carwile was supported by the Training Program in Environmental Epidemiology under grant T32 ES 007069 and the Training Program in Reproductive, Perinatal, and Pediatric Epidemiology under grant T32 HD 060454.

The authors have declared they have no conflicts of interest

Copyright © 2013 by the American Society for Colposcopy and Cervical Pathology