4.2 | Strengths and limitations
To our knowledge, this is the first population-based longitudinal prospective study in which the prognostic value of AHPV-GT combined with age stratification for triaging women with histological LSIL (CIN1) preceded by AHPV-positive/normal or mildly abnormal cytology has been assessed. A major strength of this study was that we used a larger sample size to compare the 2-year CIRs of CIN2+ and CIN3+ stratified by baseline AHPV-GT genotyping. Moreover, based on the threshold of CIN3+ risk in the 2019 ASCCP guidelines,11, 27 we recommend a management algorithm for women with histologic LSIL (CIN1) preceded by AHPV-positive/normal or mildly abnormal cytology.
This study has several limitations. First, the 2-year follow-up period in this study is relatively short compared to the 2019 ASCCP guidelines,11 which recommend that women with histological LSIL (CIN1) should have consecutive visits for at least 2 years. Second, according to the 2012 ASCCP guidelines,9 women with histology-confirmed CIN2+ underwent treatment instead of follow-up up to 2 years, which may have resulted in an underestimation of the 2-year CIR of CIN3+. Third, an inherent weakness of cohort studies is the difficulty of distinguishing new diseases from baseline-related progression. As in previous studies, it was unclear whether the HPV genotyping status of women who progressed to CIN2+ lesions was completely consistent at diagnosis and baseline.