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.