# Risk factors of histologic upgrade between colposcopy-directed biopsy and loop electrosurgical excision procedure in cervical squamous intraepithelial lesions: a retrospective study

## TL;DR

This study identifies risk factors for cervical lesion severity increasing from biopsy to surgery, focusing on HPV16/18 and transformation zone types.

## Contribution

The study introduces new evidence linking HPV16/18 infection and cervical transformation zone type to histologic upgrade in cervical lesions.

## Key findings

- HPV16 and HPV18 infections are significant risk factors for histologic upgrade from CDB to LEEP.
- Non-fully visible cervical transformation zones (type 3) are more likely to show histologic upgrade than type 2.
- Among LSIL patients, 79 showed histologic upgrade, and among HSIL patients, 19 were diagnosed with cervical cancer.

## Abstract

The aim of this study is to compare the pathological outcomes between colposcopy-directed biopsy (CDB) and loop electrosurgical excision procedure (LEEP) in patients diagnosed with cervical squamous intraepithelial lesions (SIL), and to evaluate the risk factors correlated with histologic upgrade from CDB to subsequent LEEP conization.

This retrospective study included a total of 1,496 patients who underwent LEEP after receiving pathological confirmation of cervical SIL through CDB. Statistical analysis was employed to assess the risk factors associated with the histologic upgrade of biopsy.

The study cohort was composed of 410 patients initially categorized with LSIL and 1,086 identified with HSIL, who subsequently underwent LEEP surgery. Among the LSIL-patients diagnosed via CDB, 79 showed instances of biopsy histologic upgrade. The analysis revealed that HPV16 (p < 0.001, OR 95% CI [1.58, 5.02]), HPV18 (p < 0.001, OR 95%CI [2.11, 9.29]), and type of cervical transformation zone (p < 0.001) were substantial risk factors leading to histologic upgrade in patients identified with LSIL by CDB. Out of the 1,086 patients who received pathological confirmation of HSIL through CDB, 19 were additionally diagnosed with cervical cancer. Among the upgraded patients, none represented type 1 cervical transformation zone. Furthermore, type 3 transformation zone was notably more susceptible to histologic upgrade compared to type 2 transformation zone (χ2 = 8.83, p = 0.003). Univariate analysis revealed HPV16 (p = 0.049, OR 95%CI [1.00, 6.58]) and HPV18 infection (p < 0.001, OR 95% CI [2.50, 18.40]) were significant contributors to the histologic upgrade of HSIL.

Our study identified that HPV16/18 infection and a non-fully visible cervical transformation zone are significant risk factors associated with histologic upgrade between CDB and subsequent LEEP conization.