Colposcopic Findings and Diagnosis in Low-Income Brazilian Women with ASC-H pap Smear Results

Abstract

Objective To determine the accuracy of colposcopy findings in diagnosing cervical intraepithelial neoplasia (CIN) in women with an atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) pap smear result and analyze whether the prevalence of HSIL and cancer correlates with sociodemographic risk factors and specific colposcopic findings. Methods Colposcopic findings and sociodemographic risk factors were analyzed as possible predictors of a CIN 2 or worse diagnosis in women with an ASC-H pap smear result. Results Accuracy of the colposcopic impression was 92%, sensitivity was 91.6%, and specificity was 93.1%, with a positive predictive value of 96.4% and negative predictive value of 84.3%. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. Identification of major colposcopic findings, dense acetowhite epithelium, coarse mosaicism, and punctuation correlated significantly with CIN 2 or worse. Conclusion Colposcopy performed by an experienced examiner can accurately differentiate patients with CIN 1 or less from patients with CIN 2 or worse. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. The degree of acetowhite changes was the best colposcopic feature to predict CIN2 or worse.

Predictors of CIN2+ in Patients with PAP III-P (ASC-H): A Cross-Sectional Study

“…In this context, a type 3 transformation zone was a protective factor, reducing the risk of significant pathology by a factor of 0.244 ( Table 3 ) compared to patients with a T1 transformation zone. This result is consistent with a recently published study by Maffini et al, who confirmed a type 3 transformation zone finding as a significant protective factor [ 34 ]. We hypothesize that T3 transformation zones are associated with older and postmenopausal patients, in whom ASC-H results are more often associated with atrophic changes than in younger patients.…”

“…Considering the association between age and menopausal status, premenopausal women with ASC-H are more likely to show significant pathology than postmenopausal women [ 17 , 35 , 37 , 38 , 39 , 40 ]. Few studies with small sample sizes examine menopausal status as an isolated influential factor with respect to disease outcome in ASC-H [ 34 , 38 ]. These described only a borderline correlation between premenopausal status and CIN2+ outcome [ 34 ] or no significant influence of menopausal status at all [ 38 ].…”

“…Few studies with small sample sizes examine menopausal status as an isolated influential factor with respect to disease outcome in ASC-H [ 34 , 38 ]. These described only a borderline correlation between premenopausal status and CIN2+ outcome [ 34 ] or no significant influence of menopausal status at all [ 38 ]. On the other hand, results from Saad et al [ 42 ] and Selvaggi et al [ 43 ] support the presumed relationship between menopausal status and significant pathology in ASC-H patients.…”

“…However, ASC-H is a rare subcategory, and this study collected a variety of sociodemographic and clinical risk factors and included a wide range of patients. Previous research on predictors of clinically significant disease in ASC-H patients has frequently drawn on fewer cases or only looked at a small number of putative predictors [ 34 , 38 ]. The results presented here provide important information for future research in prospective studies with larger numbers of cases.…”