Concordance ofHPV, conventional smear, colposcopy, and conization results in cervical dysplasia

Abstract

Background Cervical cancer screening algorithms are increasingly focused on Human Papillomavirus (HPV)‐based screening while the accuracy of using abnormal cytological findings to detect dysplastic lesions still remains important. This retrospective study correlated the results of conventional cervical cytology, colposcopy guided biopsy, and cold knife conization (CKC) procedures performed in a tertiary center. Materials and Methods Data from 9399 patients who underwent screening with conventional cervical cytology between 2010 and 2019 was obtained from the hospital registry. Abnormal cervical cytology and high‐risk HPV DNA genotypes were recorded and their colposcopic and CKC pathology was determined. Results Two hundred and ninety two patients underwent colposcopy for abnormal cervical cytology and/or high‐risk HPV positivity. One hundred and twenty three patients were positive for High‐risk HPV. Abnormal cervical cytology was detected in 216 patients. The most common cytological anomaly was atypical squamous cells of undetermined significance (ASCUS) found in 9399 patients (1.39%). It was determined that conventional cytology had a sensitivity of 70.8% and a specificity of 62.2% for the detection of low‐grade lesions, while it had a sensitivity of 72.4% and a specificity of 86.0% for the detection of high‐grade lesions. CKC was applied to 68 patients who were diagnosed with high‐grade squamous intraepithelial lesions (HSIL) as a result of the colposcopy. As a result of CKC, a high‐grade lesion was detected in 73.5% of these patients. Conclusion Conventional cervical cytology and colposcopy exhibited higher accuracy as the severity of lesions increased. Detection of HPV may prevent unnecessary surgical procedures, especially with ASCUS.

Underestimated Cervical Cancer among Women over 65 Years Old: Is It Time to Revise the Screening Target Age Group?

“…Other studies showed that conventional cytology had an overall sensitivity of 50 to 75% for detecting low-grade lesions and of 55 to 90% for high-grade lesions (CIN II/III). 8,10,11 Considering women whose cytological results have highgrade characteristics with indications to proceed directly to colposcopy and possible biopsy, 54.4% underwent a second cytological test, not following the current guidelines. Of this group, 29.1% had some type of neoplasm in a later biopsy.…”

“…Other studies showed that conventional cytology had an overall sensitivity of 50 to 75% for detecting low-grade lesions and of 55 to 90% for high-grade lesions (CIN II/III). 8 10 11 …”

The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions

“…Mustard yellow areas with distinct borders suggest more severe disease [ 11 ]. Colposcopy assessment more often overestimates the severity of lesions; however, given the minor side effects of biopsy and the substantial morbidity that may follow a false-negative, and detection of HPV may prevent unnecessary surgical procedures, especially with ASCUS [ 12 ]. Because the colposcopic diagnosis of pre-invasive cervical carcinoma has a sensitivity ranging from 79% to 82% and specificity ranging from 73% to 87% [ 13 ], keeping colposcopy in the gynecologist’s toolbox is advisable, and new colposcopy approaches are being developed [ 14 ].…”