{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:51:26Z","timestamp":1787237486781,"version":"build-2736575974"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Cancer Control"],"published-print":{"date-parts":[[2026,2,19]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Managing biopsy-confirmed cervical intraepithelial neoplasia grade 2 (CIN2) in women of reproductive age poses clinical challenges. Immediate treatment with large-loop excision of the transformation zone (LLETZ) is associated with a substantial risk of adverse obstetric outcomes. This study aimed to identify the risk factors for predicting CIN3+ lesions in reproductive-aged women with biopsy-diagnosed CIN2, to inform personalized management strategies that are particularly relevant to China\u2019s evolving fertility policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study analyzed the data from a regional cervical lesion screening database. Reproductive-aged women (&lt;45 years) with biopsy-confirmed CIN2 who underwent subsequent LLETZ between 2016-2024 were included in the study (n=516). Pathological upgrade was defined as CIN3+ in the LLETZ specimen. Univariate and multivariate logistic regression analyses identified independent risk factors for pathological upgrade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Following LLETZ, 18.4% (95\/516) of the women had CIN3+ lesions, indicating biopsy underestimation. HPV 16 (56.3%) and HPV 52 (27.5%) were the most prevalent genotypes in CIN3+ and CIN2- groups, respectively. Multivariable analysis identified three independent predictors: liquid-based cytology (TCT) \u2265HSIL (OR = 6.308; 95% CI: 2.390-16.650;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt;0.001); specific HR-HPV genotypes: HPV 16 infection (OR = 2.372; 95% CI: 1.165-4.831;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.017) and HPV 33 infection (OR = 3.263; 95% CI: 1.035-10.292;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.044); endocervical curettage (ECC) \u2265CIN2 (OR = 3.067; 95% CI: 1.474-6.384;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.003). Age did not increase the risk of developing CIN3+ lesions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This risk-stratification model offers evidence-based guidance for optimizing individualized treatment decisions in clinical settings where fertility preservation is prioritized.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10732748261427836","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T10:21:01Z","timestamp":1773224461000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Risk Stratification for Underlying Cervical Intraepithelial Neoplasia Grade (CIN)3+ in Reproductive-Age Women With Biopsy-Confirmed CIN2: Implications for Fertility-Preserving Management"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4549-2806","authenticated-orcid":false,"given":"Hangjing","family":"Gao","sequence":"first","affiliation":[{"name":"Fujian Maternity and Child Health Hospital"},{"name":"Fujian Key Laboratory of Women and Children\u2019s Critical Diseases Research [Fujian Maternity and Child Health Hospital"},{"name":"(Fujian Women and Children\u2019s Hospital)]"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiao","family":"Gao","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital"},{"name":"Fujian Key Laboratory of Women and Children\u2019s Critical Diseases Research [Fujian Maternity and Child Health Hospital"},{"name":"(Fujian Women and Children\u2019s Hospital)]"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9129-1522","authenticated-orcid":false,"given":"Lifang","family":"Xue","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital"},{"name":"Fujian Key Laboratory of Women and Children\u2019s Critical Diseases Research [Fujian Maternity and Child Health Hospital"},{"name":"(Fujian Women and Children\u2019s Hospital)]"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Lin","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital"},{"name":"Fujian Key Laboratory of Women and Children\u2019s Critical Diseases Research [Fujian Maternity and Child Health Hospital"},{"name":"(Fujian Women and Children\u2019s Hospital)]"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diling","family":"Pan","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiqi","family":"Huang","sequence":"additional","affiliation":[{"name":"Fujian Provincial Cervical Disease Diagnosis and Treatment Health Center"},{"name":"Fujian Maternity and Child Health Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huifeng","family":"Xue","sequence":"additional","affiliation":[{"name":"Fujian Provincial Cervical Disease Diagnosis and Treatment Health Center"},{"name":"Fujian Maternity and Child Health Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenhong","family":"Wang","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital"},{"name":"Fujian Key Laboratory of Women and Children\u2019s Critical Diseases Research [Fujian Maternity and Child Health Hospital"},{"name":"(Fujian Women and Children\u2019s Hospital)]"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqi","family":"Sun","sequence":"additional","affiliation":[{"name":"Fujian Maternity and Child Health Hospital"},{"name":"Fujian Key Laboratory of Women and Children\u2019s Critical Diseases Research [Fujian Maternity and Child Health Hospital"},{"name":"(Fujian Women and Children\u2019s Hospital)]"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,3]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2008.07.045"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(08)70103-7"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000525"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30700-3"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1284"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)68181-6"},{"issue":"11","key":"e_1_3_7_8_2","first-page":"Cd012847","article-title":"Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease","volume":"11","author":"Kyrgiou M","year":"2017","unstructured":"Kyrgiou M, Athanasiou A, Kalliala IEJ, et al. Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev. 2017;11(11):Cd012847.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_7_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.08.008"},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k499"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.3802\/jgo.2019.30.e29"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.2147\/CMAR.S179724"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-147-8-200710160-00010"},{"issue":"10","key":"e_1_3_7_14_2","first-page":"1992","article-title":"The 2001 Bethesda System terminology","volume":"68","author":"Apgar BS","year":"2003","unstructured":"Apgar BS, Zoschnick L, Wright TCJr. The 2001 Bethesda System terminology. Am Fam Physician. 2003;68(10):1992-1998.","journal-title":"Am Fam Physician"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e31827001d5"},{"key":"e_1_3_7_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17200"},{"key":"e_1_3_7_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.07.018"},{"key":"e_1_3_7_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-018-4330-9"},{"key":"e_1_3_7_19_2","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/8130373"},{"key":"e_1_3_7_20_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12985-018-1003-x"},{"key":"e_1_3_7_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-020-05787-w"},{"key":"e_1_3_7_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.29959"},{"key":"e_1_3_7_23_2","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djq356"},{"key":"e_1_3_7_24_2","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005286"},{"key":"e_1_3_7_25_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02116-14"},{"key":"e_1_3_7_26_2","doi-asserted-by":"publisher","DOI":"10.1159\/000497110"},{"key":"e_1_3_7_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000529"},{"key":"e_1_3_7_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000530"},{"key":"e_1_3_7_29_2","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3182480c18"},{"key":"e_1_3_7_30_2","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000006689"},{"key":"e_1_3_7_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.09.039"},{"key":"e_1_3_7_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2004.02.065"},{"key":"e_1_3_7_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2010.06.048"},{"key":"e_1_3_7_34_2","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0b013e3181fb4547"},{"key":"e_1_3_7_35_2","doi-asserted-by":"publisher","DOI":"10.1097\/LGT.0000000000000697"}],"container-title":["Cancer Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261427836","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10732748261427836","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10732748261427836","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:15:25Z","timestamp":1779185725000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10732748261427836"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,19]]},"references-count":34,"alternative-id":["10.1177\/10732748261427836"],"URL":"https:\/\/doi.org\/10.1177\/10732748261427836","relation":{},"ISSN":["1073-2748","1526-2359"],"issn-type":[{"value":"1073-2748","type":"print"},{"value":"1526-2359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,19]]},"article-number":"10732748261427836"}}