The relationship of community biopsy-diagnosed cervical intraepithelial neoplasia grade 2 to the quality control pathology-reviewed diagnoses: An alts report

Philip E. Castle, Mark H. Stoler, Diane Solomon, Mark Schiffman

Research output: Contribution to journalArticle

148 Scopus citations


We examined the predictors (cytologic interpretations, pathology review, human papillomavirus [HPV] testing results, and colposcopic impressions) of precancer among 545 women with clinical center biopsy diagnoses of cervical intraepithelial neoplasia (CIN) 2 in the ASCUS LSIL Triage Study. Among women with a CIN 2 biopsy result, there was an increasing likelihood that the loop electrosurgical excision procedure (LEEP) tissue sample was diagnosed as precancer (CIN 3) with an increasing number of clinical risk factors of cervical precancer (high-grade squamous intraepithelial lesion [HSIL] cytology, high-grade colposcopy, detection of HPV type 16; Ptrend < .0005). In a multivariate model, using a case definition of worst histologic diagnosis made by the quality control pathology review of biopsy and LEEP tissue samples, HPV-16 was positively associated (odds ratio [OR], 4.8; 95% confidence interval [CI], 2.6-8.8) with a CIN 3 diagnosis, whereas testing negative for HPV or positive for noncarcinogenic HPV types was negatively associated (OR, 0.32; 95% CI, 0.14-0.75) with a CIN 3 diagnosis. Although we found clear evidence that HPV-16 detection helped clarify whether a biopsy specimen diagnosed as CIN 2 represented HPV infection or cervical precancer, this relationship was not sufficiently robust to be clinically useful for reducing the overtreatment of women with HPV infection.

Original languageEnglish (US)
Pages (from-to)805-815
Number of pages11
JournalAmerican journal of clinical pathology
Issue number5
StatePublished - May 1 2007
Externally publishedYes



  • Biopsy
  • CIN
  • Cervical intraepithelial neoplasia
  • Colposcopy
  • Cytology
  • HPV
  • Human papillomavirus
  • Loop electrosurgical excision procedure

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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