IDENTIFYING RISK FACTORS FOR PROGRESSION OF CERVICAL LOW-GRADE INTRAEPITHELIAL LESIONS IN FEMALE ATHLETES

Abstract

Objective: This study investigates the risk factors associated with the progression of low-grade squamous intraepithelial lesions (LSIL) to higher-grade lesions in female athletes following loop electrosurgical excision procedure (LEEP). Methods: We conducted a retrospective analysis of 257 female athletes who underwent LEEP for LSIL at the Third Affiliated Hospital of Guangzhou Medical University between September 2010 and December 2020. Patients were categorized based on postoperative outcomes into either a pathologically upgraded group or a non-upgraded group, and further divided based on recurrence status. Univariate and multivariate logistic regression analyses were used to identify factors influencing pathological progression. Results: Of the 257 cases, 31 (12.06%) progressed to high-grade squamous intraepithelial lesions (HSIL), 216 (84.05%) remained LSIL, and 10 (3.89%) were downgraded to normal/inflammation. Univariate analysis identified HPV status, ThinPrep cytologic test (TCT) results, endocervical curettage (ECC) results, the type of cervical transformation zone, and the extent of lesion involvement as potential risk factors. Multivariate analysis confirmed positive HPV16, TCT results suggesting ASC-H/HSIL/AGC, and positive ECC as independent risk factors for pathological upgrading post-LEEP. The cure rate post-surgery was 96.89%, with a disease recurrence rate of 7%. Conclusion: Female athletes presenting with LSIL and positive indicators such as HPV16, ASC-H/HSIL/AGC on TCT, or positive ECC results are at increased risk for developing higher-grade cervical lesions. Early and aggressive management in these cases is crucial to mitigate progression, reduce recurrence rates, and improve overall prognosis. Identifying these risk factors preoperatively can enhance the precision of pathological predictions and aid in the development of effective treatment plans for female athletes, ensuring minimal disruption to their training and competitive schedules.