Cervical cancer is the third most common gynaecological cancer in the female population with 13,240 new cases estimated in 2018 [canger.gov]. It is caused by human papillomavirus(HPV) in 99.7% of cases worldwide [Walboomers 1999] and it is usually preceded by a long pre-invasive phase. Pap smear identifies cytological alterations of cells. After the cytological screening, the second step is generally the colposcopy, and thus a biopsy in case of suspicious lesion. Histological exam gives information about the degree of eventual dysplasia which are divided in 3 progressive precancerous lesions, called Intraepithelial Cervical Neoplasms (CIN 1-2-3). Depending on the grade of alteration, the lesion can regress alone without any treatment; this occurs in around 60% of CIN 1 while just in the 33% of CIN 3[Oster 1993]. Thus the role of the second step is principally to identify CIN 3. Unfortunately, the sensitivity and specificity of colposcopy is not so high, being 92% and 67% respectively [Mert 2015]. Thus new markers are necessary to select high risk patients. Nowadays it has been demonstrated that inflammation contributes to the triggering and progression of tumors. Several authors have placed their attention on inflammatory markers [ Kose 2015; Tavares-Murta 2010;Wang D 2013; Gunaldi 2015] and among these, the absolute neutrophil count on lymphocytes (NLR) is the most studied in recent literature[Zahorec 2001; Acmaz 2014; Wang 2011]. Tavares-Murta in 2010 showed that there is a correlation between NLR and cervical cancer invasion [Tavares-Murta 2010] and coherently other authors have shown that NLR is higher in the patients with cervical cancer than those with pre-invasive lesions [Fernandes Jr 2007; Mesut 2015]. However, in the literature, data regarding the role of NLR in pre-invasive lesions are still poor.
In this scenario, we want to evaluate if there is any difference in the median value of NLR between CIN 3 and general population.
Intraepithelial cervical neoplasms are widespread in the female population. Pap smear is the screening test to identify women which have to undergo colposcopy. But it is not an iter without drawbacks and devoid of negative aspects. First of al, in the female population, there is a poor compliance with performing pap smear at regular intervals and it is possible that the sample is inadequate. This obviously creates a further problem for the patients. Moreover, it is now proved that pap smear has a high false negative rate (about 40%) which means that some cases of possible CIN 3 don't be found by this test. Unfortunately, the sensitivity and specificity of colposcopy are not so high, being 92% and 67% respectively.For these reason, the discovery of a difference in NLR between CIN 3 and control group might revolutionize the diagnostic iter of preneoplastic diseases of the cervix. The blood count could be a well tolerated and low cost mean to detect patients with CIN3, risky patients who need colposcopy or a closer surveillance in case of previous CIN.