Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Abstract

!Introduction: Many factors can affect the accuracy of colposcopically guided biopsy, endocervical curettage (ECC) and differential cytology, all of which are standard, minimally invasive procedures used to detect cervical intraepithelial neoplasia. Method: All conizations carried out between 2007 and 2013 in the gynecological department of Hannover Medical School were retrospectively reviewed. The agreement between colposcopic diagnosis and histology was evaluated retrospectively. The analysis included 593 complete datasets out of a total of 717 cases treated. Results: The overall agreement was 85.5 %; the accuracy was significantly higher (p = 0.029) when three biopsy specimens were taken rather than just one. The agreement between diagnosis and histological findings from conization was highest for women < 30 years (90.7%) and lowest for women > 50 years (72.1%; p = 0.008). The agreement between preoperative differential cytology and histology results after conization was 86.7 % and improved as patient age increased (p = 0.035). The agreement between ECC findings and the results of conization was only 49.1 % irrespective of patient age, transformation zone or the patientʼs menopausal status. Conclusion: The accuracy of colposcopically guided biopsy appears to increase when three biopsy specimens are taken and is particularly high for younger patients. Differential cytology was also found to be highly accurate and is particularly useful for patients aged more than 50 years. The accuracy of ECC was significantly lower; however ECC can provide important additional information in selected cases.

Accuracy of colposcopy‐directed biopsy vs dynamic spectral imaging directed biopsy in correctly identifying the grade of cervical dysplasia in women undergoing conization: A methodological study

“…1 Recent studies have shown suboptimal sensitivities of colposcopy with high inter-observer variation 2,3 and ability to correctly diagnose cervical dysplasia positively correlated with the number of biopsies taken. [4][5][6] To avoid under-diagnosis of cervical intraepithelial neoplasia (CIN), the Danish national guidelines on cervical dysplasia 7 recommend that four biopsies are taken in every woman who undergoes colposcopy.…”

“…17 Using a standard colposcope the agreement rate between histological diagnosis of colposcopy-directed biopsies (CDB) and histological diagnosis of conization specimens have been found to vary between 45% 18 and 89.6%. 5,[19][20][21][22] To the best of our knowledge, no study has compared the histological diagnosis of the biopsy/ies taken with the DSI colposcope to the histological diagnosis of the conization specimen.…”

Study of Cervical Biopsy over a Decade at a Tertiary Level Hospital, Nepal

“…19 The accuracy of colposcopy guided biopsy appears to increase when three biopsy specimens were taken and was particularly high for younger patients. 20 In this study, only fifteen premalignant cases and three cervical cases were detected out of 168 colposcopy guided procedures. Colposcopy, the single and irreplaceable second-level procedure for triage of cervical abnormalities, is challenged to match the today's screening tests, especially in view of the extended intervals that increase the risks for patients with missed disease.…”

Comparison of Diagnostic Methods in Detection of Squamous Cell Abnormalities in Iranian Women with Abnormal Pap’s Smear Test and Associated Demographic and Issues

“…Which was similar to other studies. This is due to the inflammatory and premalignant lesions of the cervix (16,24,25).…”