{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:05:35Z","timestamp":1792688735594,"version":"4.5.0"},"reference-count":45,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2024,10,16]],"date-time":"2024-10-16T00:00:00Z","timestamp":1729036800000},"content-version":"vor","delay-in-days":15,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The concordance rate between conization and colposcopy\u2010directed biopsy (CDB) proven cervical high\u2010grade squamous intraepithelial lesion (HSIL) were 64\u221285%. We aimed to identify the risk factors associated with pathological upgrading or downgrading after conization in patients with cervical HSIL and to provide risk\u2010stratified management based on a machine learning predictive model.<\/jats:p>\n                  <jats:p>This retrospective study included patients who visited the Obstetrics and Gynecology Hospital of Fudan University from January 1 to December 31, 2019, were diagnosed with cervical HSIL by CDB, and subsequently underwent conization. A wide variety of data were collected from the medical records, including demographic data, laboratory findings, colposcopy descriptions, and pathological results. The patients were categorized into three groups according to their postconization pathological results: low\u2010grade squamous intraepithelial lesion (LSIL) or below (downgrading group), HSIL (HSIL group), and cervical cancer (upgrading group). Univariate and multivariate analyses were performed to identify the independent risk factors for pathological changes in patients with cervical HSIL. Machine learning prediction models were established, evaluated, and subsequently verified using external testing data.<\/jats:p>\n                  <jats:p>In total, 1585 patients were included, of whom 65 (4.1%) were upgraded to cervical cancer after conization, 1147 (72.4%) remained having HSIL, and 373 (23.5%) were downgraded to LSIL or below. Multivariate analysis showed a 2% decrease in the incidence of pathological downgrade for each additional year of age and a 1% increase in lesion size. Patients with cytology &gt; LSIL (odds ratio [OR]\u2009=\u20090.33; 95% confidence interval [CI], 0.21\u20130.52), human papillomavirus (HPV) infection (OR\u2009=\u20090.33; 95% CI, 0.14\u20130.81), HPV 33 infection (OR\u2009=\u20090.37; 95% CI, 0.18\u20130.78), coarse punctate vessels on colposcopy examination (OR\u2009=\u20090.14; 95% CI, 0.06\u20130.32), HSIL lesions in the endocervical canal (OR\u2009=\u20090.48; 95% CI, 0.30\u20130.76), and HSIL impression (OR\u2009=\u20090.02; 95% CI, 0.01\u20130.03) were less likely to experience pathological downgrading after conization than their counterparts. The independent risk factors for pathological upgrading to cervical cancer after conization included the following: age (OR\u2009=\u20091.08; 95% CI, 1.04\u20131.12), HPV 16 infection (OR\u2009=\u20094.07; 95% CI, 1.70\u20139.78), the presence of coarse punctate vessels during colposcopy examination (OR\u2009=\u20092.21; 95% CI, 1.08\u20134.50), atypical vessels (OR\u2009=\u20096.87; 95% CI, 2.81\u201316.83), and HSIL lesions in the endocervical canal (OR\u2009=\u20092.91; 95% CI, 1.46\u20135.77). Among the six machine learning prediction models, the back propagation (BP) neural network model demonstrated the highest and most uniform predictive performance in the downgrading, HSIL, and upgrading groups, with areas under the curve (AUCs) of 0.90, 0.84, and 0.69; sensitivities of 0.74, 0.84, and 0.42; specificities of 0.90, 0.71, and 0.95; and accuracies of 0.74, 0.84, and 0.95, respectively. In the external testing set, the BP neural network model showed a higher predictive performance than the logistic regression model, with an overall AUC of 0.91. Therefore, a web\u2010based prediction tool was developed in this study.<\/jats:p>\n                  <jats:p>BP neural network prediction model has excellent predictive performance and can be used for the risk stratification of patients with CDB\u2010diagnosed HSIL.<\/jats:p>","DOI":"10.1002\/jmv.70016","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:25:18Z","timestamp":1729124718000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Risk\u2010stratified management of cervical high\u2010grade squamous intraepithelial lesion based on machine learning"],"prefix":"10.1002","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9112-5615","authenticated-orcid":false,"given":"Lu","family":"Zhang","sequence":"first","affiliation":[{"name":"Cervical Disease Center Obstetrics and Gynecology Hospital of Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pu","family":"Tian","sequence":"additional","affiliation":[{"name":"Cervical Disease Center Obstetrics and Gynecology Hospital of Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0924-9673","authenticated-orcid":false,"given":"Boning","family":"Li","sequence":"additional","affiliation":[{"name":"Cervical Disease Center Obstetrics and Gynecology Hospital of Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Minhang District Central Hospital Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-1741","authenticated-orcid":false,"given":"Lihua","family":"Qiu","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Renji Hospital, School of Medicine Shanghai Jiao Tong University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaori","family":"Bi","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Integrated Chips and Systems Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Limei","family":"Chen","sequence":"additional","affiliation":[{"name":"Cervical Disease Center Obstetrics and Gynecology Hospital of Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0921-4366","authenticated-orcid":false,"given":"Long","family":"Sui","sequence":"additional","affiliation":[{"name":"Cervical Disease Center Obstetrics and Gynecology Hospital of Fudan University Shanghai China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,10,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70103-7"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e318287d329"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-018-4953-8"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.currproblcancer.2018.01.010"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000061"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-012-2493-1"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000132803.88049.84"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2011-0494-OA"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3182aa08f6"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0000000000000152"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2015.01.015"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.5468\/ogs.2018.61.4.477"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCP6BSD0SNGQLHQ"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k499"},{"issue":"12","key":"e_1_2_8_16_1","first-page":"1148","article-title":"Negative loop electrosurgical excision procedure (LEEP) following cervical biopsy diagnosis of high grade squamous intraepithelial lesion","volume":"14","author":"Aly FZ","year":"2021","journal-title":"Int J Clin Exp Pathol"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l1161"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.31557\/APJCP.2019.20.3.849"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.3802\/jgo.2020.31.e13"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g6192"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i3633"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.55.9948"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3182480c18"},{"key":"e_1_2_8_24_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/5138232","article-title":"A large retrospective study of 12714 cases of LEEP conization focusing on cervical cancer that Colposcopy\u2010Directed biopsy failed to detect","volume":"2018","author":"Cong Q","year":"2018","journal-title":"BioMed Res Int"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32003"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10552-013-0162-8"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2020.04.685"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2019.07.003"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000124"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3182a5296e"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.048"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.7314\/APJCP.2014.15.8.3461"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002330"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.18632\/oncotarget.15658"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3182a0b572"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2017.07.005"},{"issue":"9","key":"e_1_2_8_37_1","first-page":"613","article-title":"[Analysis of the missed diagnosis of invasive carcinoma under the microscope in HSIL diagnosed by colposcopy\u2010guided biopsy and related influencing factors]","volume":"53","author":"Qian XY","year":"2018","journal-title":"Zhonghua Fu Chan Ke Za Zhi"},{"issue":"4","key":"e_1_2_8_38_1","first-page":"348","article-title":"Influencing factors analysis of the upgraded pathological results after cervical conization of high\u2010grade squamous intraepithelial lesions in postmenopausal women [J]","volume":"22","author":"Liu YY","year":"2021","journal-title":"Zhong Guo Fu Chan Ke Lin Chuang Za Zhi"},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.3109\/00016346409155844"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12480"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2020.06.490"},{"key":"e_1_2_8_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01860-y"},{"issue":"4","key":"e_1_2_8_43_1","first-page":"435","article-title":"Deep learning model exploration of colposcopy image based on cervical epithelial and vascular features [J]","volume":"48","author":"Li YY","year":"2021","journal-title":"Fudan Univer J Med Sci"},{"key":"e_1_2_8_44_1","volume-title":"Cervix Cancer Screening: IARC Handbooks of Cancer Prevention","author":"International Agency for research on Cancer","year":"2005"},{"issue":"8","key":"e_1_2_8_45_1","article-title":"Cytology versus HPV testing for cervical cancer screening in the general population","volume":"8","author":"Koliopoulos G","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1038\/bjc.2016.290"}],"container-title":["Journal of Medical Virology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jmv.70016","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jmv.70016","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jmv.70016","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,2]],"date-time":"2026-05-02T07:14:20Z","timestamp":1777706060000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jmv.70016"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10]]},"references-count":45,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10]]}},"alternative-id":["10.1002\/jmv.70016"],"URL":"https:\/\/doi.org\/10.1002\/jmv.70016","archive":["Portico"],"relation":{},"ISSN":["0146-6615","1096-9071"],"issn-type":[{"value":"0146-6615","type":"print"},{"value":"1096-9071","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10]]},"assertion":[{"value":"2024-03-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-07","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-16","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70016"}}