Optimization of management approaches for patients with cervical intraepithelial neoplasia mildly (LSIL) associated with high oncogenic risk human papillomaviruses

Abstract

   Objective: To improve the management of mild cervical dysplasia by correcting serum folic acid as an epigenetic risk factor for disease progression.   Materials and methods: 90 patients with different outcomes of dynamic follow-up of LSIL associated with one type of HPV VCR were included in the study (16, 18, 33). Group I — 43 patients with regression of the disease; Group II — 30 patients with persistence of HPV infection and group III — 17 patients with LSIL progression. The effectiveness of the differentiated approach to the management of patients in the study groups was assessed based on the results of cytology of cervical smears and immunocytochemical reaction, the level of viral load, the results of colposcopic examination, and the dynamics of serum folic acid levels. Statistical processing of the results was performed using IBM SPSS Statistics 28.0.1.1, STATISTICA 13.5.0.17 and MedCalc 20.027.   Results: the prognostic significance of a number of anamnestic parameters and serum folate deficiency, the totality of which can be used as predictors of disease outcome progression, has been established; a computer program has been developed to calculate the individual risk of disease progression (IRD), which facilitates the use of the developed method for calculating progression in clinical practice.   Conclusions: The proposed method with a high degree of reliability and informativeness allows predicting the progression of LSIL without violating the algorithm of current clinical recommendations, timely forming among patients a high-risk group for the development of a more severe form of the disease (HSIL) and individually determining further treatment tactics.