Colposcopy Protocols 2020

Jach, Robert; Mazurec, Maciej; Trzeszcz, Martyna; Bartosińska-Dyc, Anna; Galarowicz, Barlomiej; Kędzia, Witold; Nowakowski, Andrzej; Pityński, Kazimierz

doi:10.5603/gp.2020.0075

Cited by 9 publications

(9 citation statements)

References 34 publications

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“…The similarities to the HRHPV14-positivity of our results in all categories of abnormal cytological diagnoses were noted. Our HRHPV14-positivity rate of 48.9% for ASC-US cytology cases was within the levels reported for the US conditions, including CAP (47.73%) [31] and the Kaiser Permanente Northern California Foundation (48.39%) [17]. A meta-analysis of Arbyn et al showed an average HRHPV-positivity rate for ASC-US cytology of 43.0%, but it should be remembered that slightly lower levels compared to ours in this case might be associated with the use of a different HRHPV test, which detects less high-risk types [32] than in our study.…”

Section: Discussionsupporting

confidence: 80%

“…The effectiveness of the extended screening strategy in the HPV-based model with p16/Ki67 testing has been confirmed by FDA registration [15]. The limitations of the Polish population-based screening, the preferences of Polish women, and the growing awareness of private sector gynecologists in the new paradigms of secondary cervical cancer prevention result in the gradual implementation of the globally recommended HPV-based screening strategies with proven higher effectiveness [2,16] in Polish private gynecological care [17,18]. Interim screening guidelines in the SARS-CoV-2 pandemic of 2021 [18] include the 2019 risk-based management guidelines of the American Society of Colposcopy and Cervical Pathology (ASCCP) [16] as one of the screening options.…”

Section: Introductionmentioning

confidence: 98%

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Liquid-Based Screening Tests Results: HPV, Liquid-Based Cytology, and P16/Ki67 Dual-Staining in Private-Based Opportunistic Cervical Cancer Screening

et al. 2021

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The baseline data from the private-based opportunistic cervical cancer screening with HRHPV14, liquid-based cytology (LBC) and p16/Ki67 testing, and its quality assessment/quality control (QA/QC) tools are lacking. The age-stratified analysis of 30,066 screening tests results in a Polish population, including the investigation of HRHPV14 status, LBC, and p16/Ki67 dual-staining reporting rates, along with immediate histopathologic correlations, was conducted. For cytopathologic QA/QC, the College of American Pathologists (CAP) benchmarks and enhanced safety protocol were used. The NILM/ASC-US/LSIL/ASC-H/HSIL/AGC reporting rates were 93.9/3.4/2.0/0.22/0.24/0.11, respectively, with correlating HRHPV14-positive rates of 8.4/48.9/77.2/84.6/90.7/26.7. The reporting rates for HSIL (CIN2+) in HRHPV-positive women with NILM/ASC-US/LSIL/ASC-H/HSIL/AGC referred for a colposcopy with biopsy were 19.1/25.8/22.5/12.4/19.1/1.1% of the total HSIL (CIN2+). In total, of the 1130 p16/Ki67 tests, 30% were positive. In NILM HRHPV14-positive women with available histology result, HSIL(CIN2+) was detected in 28.3% of cases. In the first such large-scale Polish study presenting HRHPV14, informed LBC and HSIL (CIN2+) results, the reporting rates were highly consistent with data from American and other CAP-certified laboratories, confirming the possibility of using the 2019 ASCCP risk-based guidelines as one of the screening strategies outside of the US, in conditions of proper QA/QC. The private-based screening model can be effective in cervical cancer prevention, particularly in countries with low population coverage of public funds-based systems.

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Section: Discussionsupporting

confidence: 80%

Section: Introductionmentioning

confidence: 98%

Liquid-Based Screening Tests Results: HPV, Liquid-Based Cytology, and P16/Ki67 Dual-Staining in Private-Based Opportunistic Cervical Cancer Screening

et al. 2021

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“…However, we are aware that any change to the current protocols would take time, validation through scientific data, and discussion within accredited societies. We are also convinced that this policy would indeed mean not only a big change in colposcopy practice, first of all in follow-up timing modifications and delayed referral to colposcopy for ASC-US/LSIL cases positive for lowest risk HPV group genotypes (35,39,51,56,59, 66 and 68), but also less costs and less patient anxiety. A stratification of each patient's own risk of CIN3+ at screening could help towards tailored management [14,[22][23][24].…”

Section: Applying Risk-based Stratification To the Italian Screening Settingmentioning

confidence: 94%

“…The addition of HPV 31 to HPV 16/18, as part of a primary HPV screening algorithm recommendation for colposcopy, offers potential benefits for the detection of high-grade cervical disease in the NILM cytology population [20]. Human papillomavirus 16 consistently carried the highest risk for CIN3+ (approximately 15-35% for any cytology and approximately 8-25% for normal cytology), HPV 31, 18, and 33 carried intermediate-high risk for CIN3+ (ranging from approximately 8% to 20% in any cytology and approximately 5% to 10% in normal cytology), HPV 52, 58, and 45 carried moderate risks, with HPV 35,39,51,56,59, 66, and 68 consistently having the lowest CIN3+ rates, regardless of cytology [20][21][22][23]. While recent studies highlight the possible role of HPV genotyping for clinical management of abnormal screening results, further evidence is still needed to assess both, the value of genotyping in different clinical settings (screening, diagnosis, treatment, and follow-up) and the additional risk stratification of more detailed genotyping.…”

Section: Primary Screening Test and Colposcopy In The Vaccination Eramentioning

confidence: 99%

“…Of those, the HSIL cytologies would clearly need direct colposcopy. Even cytologies ASC-US/LSIL positive for 33, 45, 52, and 58 HPVs would be referred to colposcopy, while other low-grade cytologies positive for 35,39,51,56,59, 66, and 68 would go to control after 1 year such as negative cytologies. However, we are aware that any change to the current protocols would take time, validation through scientific data, and discussion within accredited societies.…”

Section: Applying Risk-based Stratification To the Italian Screening Settingmentioning

confidence: 99%

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Are We Facing a New Colposcopic Practice in the HPV Vaccination Era? Opportunities, Challenges, and New Perspectives

et al. 2021

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The combination of primary and secondary prevention has already influenced the colposcopic practice by reduction in HPV (human papillomavirus) vaccine-type HSIL (HIGH-GRADE SIL), colposcopy referral numbers, colposcopic positive predictive value (PPV) for CIN2+, and by modification of referral pattern, colposcopic performance, and procedures. Different strategies, both isolated and combined, have been proposed in order to maintain the diagnostic accuracy of colposcopy: patient risk stratification based on immediate or future risk of CIN3+ or on HPV genotyping after a positive screening test. Data are needed to support alternative colposcopic strategies based on vaccination status and on the application of artificial intelligence where the patient’s risk stratification is implicit in precision medicine which involves the transition from an operator-dependent morphology-based to a less-operator dependent, more biomolecular management. The patient’s risk stratification based on any combination of “history” and “test results” to decrease colposcopy workload further reduce colposcopic and histologic morphological approaches, while adding genotyping to the risk stratification paradigm means less cytologic morphologic diagnosis. In Italy, there is a strong colposcopic tradition and there is currently no immediate need to reduce the number of colposcopies. Instead, there is a need for more accredited colposcopists to maintain the diagnostic accuracy of colposcopy in the vaccination era.

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

et al. 2022

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Background Colposcopy alone can result in misidentification of high-grade squamous intraepithelial or worse lesions (HSIL +), especially for women with Type 3 transformation zone (TZ) lesions, where colposcopic assessment is particularly imprecise. This study aimed to improve HSIL + case identification by supplementing referral screening results to colposcopic findings. Methods This is an observational multicenter study of 2,417 women, referred to colposcopy after receiving cervical cancer screening results. Logistic regression analysis was conducted under uni- and multivariate models to identify factors which could be used to improve HSIL + case identification. Histological diagnosis was established as the gold standard and is used to assess accuracy, sensitivity, and specificity, as well as to incrementally improve colposcopy. Results Multivariate analysis highlighted age, TZ types, referral screening, and colposcopists’ skills as independent factors. Across this sample population, diagnostic accuracies for detecting HSIL + increased from 72.9% (95%CI 71.1–74.7%) for colposcopy alone to 82.1% (95%CI 80.6–83.6%) after supplementing colposcopy with screening results. A significant increase in colposcopic accuracy was observed across all subgroups. Although, the highest increase was observed in women with a TZ3 lesion, and for those diagnosed by junior colposcopists. Conclusion It appears possible to supplement colposcopic examinations with screening results to improve HSIL + detection, especially for women with TZ3 lesions. It may also be possible to improve junior colposcopists’ diagnoses although, further psychological research is necessary. We need to understand how levels of uncertainty influence diagnostic decisions and what the concept of “experience” actually is and what it means for colposcopic practice.

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Colposcopy Protocols 2020

Cited by 9 publications

References 34 publications

Liquid-Based Screening Tests Results: HPV, Liquid-Based Cytology, and P16/Ki67 Dual-Staining in Private-Based Opportunistic Cervical Cancer Screening

Liquid-Based Screening Tests Results: HPV, Liquid-Based Cytology, and P16/Ki67 Dual-Staining in Private-Based Opportunistic Cervical Cancer Screening

Are We Facing a New Colposcopic Practice in the HPV Vaccination Era? Opportunities, Challenges, and New Perspectives

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

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