# Risk Factors of High-Grade CIN or Cervix Cancer in Young Women with Abnormal Pap Smear Results: Who Should Be Treated with LEEP (Loop Electrosurgical Excision Procedure)?

## TL;DR

This study identifies risk factors for severe cervical abnormalities in young women with abnormal Pap smears, emphasizing the need for timely treatment and further research.

## Contribution

The study identifies specific risk factors for high-grade cervical lesions in young Korean women with abnormal Pap smears.

## Key findings

- 61.4% of women undergoing LEEP had CIN3+ and 8.2% had invasive cervical cancer.
- Independent predictors of CIN3+ included age >28, smoking, lack of regular screening, and high-risk HPV infection.
- Age ≥28 and elevated neutrophil-to-lymphocyte ratio were linked to invasive cervical cancer.

## Abstract

Objective: This study aimed to identify risk factors associated with high-grade cervical intraepithelial neoplasia (CIN3+) in young adults with abnormal Pap smears. Methods: We performed a retrospective chart review of women ≤30 years who underwent loop electrosurgical excision procedure (LEEP) for abnormal Pap results (atypical squamous cells of undetermined significance [ASCUS] or higher), between 2012 and 2022 at Dongtan Sacred Heart Hospital. Clinical characteristics, including age, HPV infection, prior gynecologic surgery, pelvic inflammatory disease (PID), complete blood count, and Pap smear screening history were collected. Women with CIN3+ based on punch biopsy or LEEP were designated as CIN3+. Results: A total of 158 women underwent LEEP. Of these, 61.4% were diagnosed with CIN3+ and 8.2% with invasive cervical cancer. Independent predictors of CIN3+ included age >28 years, smoking, lack of regular Pap screening, and high-risk HPV infection. Subgroup analysis suggested age ≥28 years and neutrophil-to-lymphocyte ratio >2.12 were risk factors for invasive cervical cancer. Conclusions: Young Korean women with abnormal Pap smears and risk factors such as older age, smoking, high-risk HPV infection, and irregular screening histories are at increased risk for CIN3+. These findings highlight the importance of timely intervention; however, because our cohort included only women who underwent LEEP, it may represent a higher-risk subset and thus introduce selection bias. Validation in larger multicenter, prospective studies incorporating fertility and recurrence outcomes are needed before definitive recommendations can be made.