Clinical application of the 2011 IFCPC colposcope terminology

Abstract

Background Colposcopy offers an accurate way to the diagnose of cervical precancerous lesions. However, the diagnostic accuracy of colposcopy is unsatisfied. This study was to evaluate colposcopic accuracy according to the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology. Methods A retrospective cohort study was performed in 1,838 patients who underwent colposcopy in Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University from October 2013 to April 2018. Using conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated, and correlations between variables were analyzed. Results As an authoritative and widely used terminology for colposcopy diagnosis, the 2011 IFCPC terminology has certain clinical practicality and diagnostic accuracy. However, some signs such as mosaic, punctation, sharp border, inner border sign and ridge sign had high specificity but unsatisfactory sensitivity, which limited the diagnostic value. Therefore, we discussed the Lugol’s staining, a very common sign in colposcopy, and analyzed the diagnostic significance of bright yellow staining in low-grade squamous intraepithelial lesion (LSIL) and mustard yellow staining in high-grade squamous intraepithelial lesion (HSIL). The results showed that mustard yellow may be a valuable indicator in the diagnosis of HSIL. Conclusion The 2011 IFCPC colposcope terminology has standardized interpretations of the colposcopic findings and improved the accuracy of colposcopy diagnosis. The aceto-white epithelium still has important diagnostic value; however, the value of a few signs is needed to be discussed and new signs are expected to be discovered. Although the significance of Lugol’s staining was diminishing, mustard yellow might be a valuable indicator for the diagnosis of HSIL.

Improving colposcopic accuracy for cervical precancer detection: a retrospective multicenter study in China

“…This seems high but again this varies substantially. For example, Zhang et al [ 10 ]. studied 1,838 cases and found 18.2% were TZ 1 or 2, and the remaining 81.8% were TZ3 cases.…”

“…Poor diagnostic performance is again more evident in LMICs where there is a shortage of skills and experienced colposcopists [ 8 ]. A high proportion of women in these countries, between 20–80%, also have TZ3 lesions [ 9 , 10 ]. Therefore, it is vital we improve colposcopic practice through research and training.…”

Lugol’s solution reduces positive resection margins and residual disease after the loop electrosurgical excision procedure

“…As of now, many studies have investigated clinical factors affecting positive resection margins [15,16] and efforts have been made to develop strategies for optimizing CIN treatment by LEEP [17,18]. The studies on the Schiller test using Lugol's solution have focused mainly on its performance in detecting CIN, not on aiding the completely removal of CIN by its role of delineating the TZ [13,19]. No previous studies have examined the substantive bene ts of Lugol's solution for LEEP, that is, affordable and amenable preoperative preparation.…”

Nomogram for predicting pathological discordance between colposcopy and cold knife conization findings in patients with colposcopically confirmed high-grade squamous intraepithelial lesions

“…The reason for this might be the heterogeneity in the distribution of different TZs. For example, in the retrospective analysis of Zhang et al that included 1,838 patients who underwent colposcopy, 18.2% of patients had TZ type 1 or 2 and 81.8% had TZ type 3 [29], while in the study of Fan et al, among the 2,262 patients studied, 83.6% had TZ type 1 or 2 and the remaining 16.4% had TZ type 3 [6]. In addition, although colposcopic overestimation appeared to positively correlate with gland involvement in different patient groups and those without gland involvement had a higher chance of overestimation, the multivariate logistic regression analysis did not identify gland involvement as an independent predicting factor.…”