Accuracy of endocervical cytological tests in diagnosing preinvasive lesions of the cervical canal in patients with type 3 transformation zone: a retrospective observational study

Abstract

BACKGROUND: Cervical cancer screening in Brazil is done using Pap smears. Women who are most likely to have a preinvasive lesion or cervical cancer are immediately referred for colposcopy. OBJECTIVE: The aim of this study was to evaluate the diagnostic performance of endocervical cytological tests in diagnosing preinvasive cervical lesions in women with initial high-grade squamous intraepithelial lesions (HSIL), or atypical squamous cells in which high-grade lesions could not be ruled out (ASC-H), or atypical glandular cells (AGC), and whose colposcopy did not show any abnormalities, with no fully visible transformation zone (types 2 and 3). DESIGN AND SETTING: Retrospective observational study conducted in Rio de Janeiro, Brazil. METHODS: Data from women who came to the cervical pathology outpatient clinic between January 2012 and April 2017 were analyzed. The results from endocervical cytological tests were compared with the final diagnosis, which was obtained through examination of a surgical specimen or, among women who did not undergo an excisional procedure, after cytological and colposcopic follow-up for two years. RESULTS: We included 78 women. The sensitivity of endocervical cytological tests was 72.7%; specificity 98.5%; positive and negative predictive values 88.9% and 95.6%, respectively; and positive and negative likelihood ratios 48.7 and 0.28. CONCLUSION: Endocervical cytological tests are simple, inexpensive and noninvasive, and form a reliable method for determining management among patients with HSIL, ASC-H and AGC cytological findings and negative colposcopic findings without visualization of the squamocolumnar junction.

Office Cervicoscopy versus Colposcopy for Evaluation of Suspicious Cervix ‎in Assiut Governorate

“…In a retrospective study, Jordão et al [12] reported that, cytological examination is a reliable and simple method to determine management options in patients with suspicious cervix and negative colposcopic data. It remains the gold-standard for diagnosis of such lesions.…”

Cervical Intraepithelial Neoplasia: Analyzing the Disease Present Exclusively in the Endocervical Canal

“…limitations, and it is necessary to histologically investigate the endocervical canal. [6][7][8] This research aims to verify the role of cytology (Pap smears), collected exclusively from the endocervical canal of the uterine cervix, in women with an abnormal cytology (suggesting a high-grade lesion), with colposcopy disagreements (whose colposcopy does not reveal injury), and submitted to a LEEP procedure for diagnosis and relate the cytology results with those histological results of the conization product, calculating the prevalence of histological lesion in the endocervical canal. In addition, it aims to identify the clinical and epidemiological characteristics of the disease presented exclusively in the endocervical canal, and to evaluate the average length of endocervical canal excised necessary to obtain a conization product with free margins, thus ensuring an appropriate treatment to prevent progression to invasive cancer, and to identify the rate of invasive cancer hidden in these specific cases.…”

“…When the patient's result shows changes with a high probability of representing cancer or preinvasive lesions, immediate referral for colposcopy is necessary. 6,7 When CIN is detected in the uterine ectocervix, or in cases that reach the endocervical canal as far as the entire transformation zone can be seen, the treatment is performed by loop electrosurgical procedure (LEEP). [5][6][7][8] However, when the lesion is located entirely in the endocervical canal, or the transformation zone is not fully visible, colposcopy has…”

“…When the patient's result shows changes with a high probability of representing cancer or preinvasive lesions, immediate referral for colposcopy is necessary. 6 7…”

“…When CIN is detected in the uterine ectocervix, or in cases that reach the endocervical canal as far as the entire transformation zone can be seen, the treatment is performed by loop electrosurgical procedure (LEEP). 5 6 7 8 However, when the lesion is located entirely in the endocervical canal, or the transformation zone is not fully visible, colposcopy has limitations, and it is necessary to histologically investigate the endocervical canal. 6 7 8…”