Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology

Abstract

Background Colposcopy is an important tool in diagnosing cervical cancer, and the International Federation of Cervical Pathology and Colposcopy (IFCPC) issued the latest version of the guidelines in 2011. This study aims to systematically assess the accuracy of colposcopy in predicting low-grade squamous intraepithelial lesions or worse (LSIL+) / high-grade squamous intraepithelial lesions or worse (HSIL+) under the 2011 IFCPC terminology. Methods We performed a systematic review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for studies about the performance of colposcopy in diagnosing cervical intraepithelial neoplasia under the new IFCPC colposcopy terminology from PubMed, Embase, Web of Science and the Cochrane database. Data were independently extracted by two authors and an overall diagnostic performance index was calculated under two colposcopic thresholds. Results Totally, fifteen articles with 22,764 participants in compliance with the criteria were included in meta-analysis. When colposcopy was used to detect LSIL+, the combined sensitivity and specificity were 0.92 (95% CI 0.88–0.95) and 0.51 (0.43–0.59), respectively. When colposcopy was used to detect HSIL+, the combined sensitivity and specificity were 0.68 (0.58–0.76) and 0.93 (0.88–0.96), respectively. Conclusion In accordance with the 2011 IFCPC terminology, the accuracy of colposcopy has improved in terms of both sensitivity and specificity. Colposcopy is now more sensitive with LSIL+ taken as the cut-off value and is more specific to HSIL+. These findings suggest we are avoiding under- or overdiagnosis both of which impact on patients’ well-being.

Evaluation of the diagnostic performance of colposcopy in the detection of cervical high-grade squamous intraepithelial lesions among women with transformation zone type 3

“…In a study also done in China, the sensitivity, specificity, and accuracy of colposcopy to diagnose histologic CIN2 + were 70.2%, 75.1% and 72.9%, respectively [ 16 ]. A recent meta-analysis showed that colposcopic accuracy for detecting CIN2 + was 89%, with combined sensitivity and specificity were 68% and 93%, respectively [ 28 ]. The sensitivity of colposcopic impressions ranged from 29 to 100% and the specificity from 12 to 88% based on 11 studies [ 29 ].…”

Development and validation of artificial intelligence-based analysis software to support screening system of cervical intraepithelial neoplasia

“…Improving the accuracy of colposcopy is the most important factor in early detection of cervical cancer. Even for experienced colposcopists, there can be errors in accurate diagnosis through colposcopy 28 , 29 . The role of cervical cancer screening through CerviCARE AI has become more important recently.…”

Detection of cervical high-grade squamous intraepithelial lesions and assessing diagnostic performance of colposcopy among women with oncogenic HPV

“…It has been reported that colposcopic diagnosis often underestimates [ 31 ] or overestimates [ 34 ] in predicting squamous intraepithelial lesions. Recently, a systematic review and meta-analysis showed that the overall accuracy was 89% when using colposcopy to detect CIN2+, with combined sensitivity and specificity 68% and 93%, respectively [ 35 ]. Interestingly, they also demonstrated that colposcopy was more sensitive to low-grade squamous intraepithelial lesions or worse (LSIL+) and was more specific to CIN2+ [ 35 ].…”

“…Recently, a systematic review and meta-analysis showed that the overall accuracy was 89% when using colposcopy to detect CIN2+, with combined sensitivity and specificity 68% and 93%, respectively [ 35 ]. Interestingly, they also demonstrated that colposcopy was more sensitive to low-grade squamous intraepithelial lesions or worse (LSIL+) and was more specific to CIN2+ [ 35 ]. The sensitivity of colposcopic diagnosis ranged from 29 to 100% and the specificity from 12 to 88% based on 11 studies [ 36 ].…”