Clinical study of TCT+HPV combined screening and lesion management for perinatal cervical cancer
Objective To evaluate the safety,necessity,and efficacy of combining thinprep cytologic test(TCT)with high-risk human papillomavirus(HPV)screening in pregnant women,and to provide a reference for managing cervical lesions during pregnancy.Methods A retrospective study was conducted with 3,120 pregnant women,who were between 12 and 20 weeks of gestation,attending the obstetrics and gynecology department of Hangzhou Fuyang Women And Children Hospital from August 2021 to April 2023.All participants underwent TCT+HPV screening.Based on the screening results,some cases were further evaluated with colposcopy and followed up at 42 days postpartum.Results Among the 3,120 pregnant women screened,132 had abnormal results.Abnormal TCT results were found in 74 cases(2.37％),and HPV16/18 positivity was detected in 87 cases(2.79％).Specifically,58 cases(1.86％)had negative for intraepithelial lesion or malignancy(NILM)with HPV16/18 positive;6 cases(0.19％)had atypical squamous cells of undetermined significance(ASC-US)with HPV16/18 negative;9 cases(0.29％)had ASC-US with HPV16/18 positive;27 cases(0.87％)had low-grade squamous intraepithelial lesions(LSIL)with HPV16/18 negative;13 cases(0.42％)had LSIL with HPV16/18 positive;12 cases(0.38％)had ASC-H or high-grade squamous intraepithelial lesions(HSIL)with HPV16/18 negative;and 7 cases(0.22％)had ASC-H or HSIL with HPV16/18 positive.A total of 32 pregnant women with LSIL+HPV16/18 positive,ASC-H or HSIL with HPV16/18 negative,and ASC-H or HSIL with HPV16/18 positive underwent colposcopy during pregnancy.Pathological reports revealed no invasive cervical cancer;findings included normal or inflammation in 10 cases,cervical intraepithelial neoplasia grade 1(CIN 1)in 15 cases,CIN 2 in 5 cases,and CIN 3 in 2 cases.At 42 days postpartum,132 women with abnormal results underwent repeat TCT+HPV and colposcopy.Abnormal TCT results were found in 34 cases,and abnormal HPV results in 36 cases.Postpartum colposcopy showed no invasive cervical cancer;findings included normal or inflammation in 104 cases,CIN1 in 24 cases,CIN2 in 3 cases,and CIN3 in 1 case.Conclusion Combined TCT and HPV screening during pregnancy is safe and similar to screening for non-pregnant women.Cervical precancerous lesions detected during pregnancy can be conservatively monitored and reassessed postpartum.Pregnancy does not exacerbate cervical precancerous lesions,and most cervical lesions identified during pregnancy may resolve postpartum.
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