Correlation of Swede score colposcopy scoring system and histopathological results in patients with high-risk HPV infection other than HPV16 and 18

Abstract

ObjectiveTriage with HPV genotyping has some caveats and debates for HPV positive cases other than 16 and 18. The Swede score colposcopic scoring system has not previously been evaluated in this group of patients.ObjectiveTo use the Swede score colposcopic scoring system to compare scores and final histopathological results in women who have undergone colposcopy owing to infection with high risk-HPVs other than HPV16 and 18 and to establish new cut-off values to predict pre-malignant lesions in this group of patients.MethodsThis study was conducted in 613 women undergoing colposcopic evaluation because of abnormal cervical cytology together with high-risk HPV infection. All patients referred were evaluated by an expert colposcopist, given a Swede score (using the Swede score colposcopic scoring system) by using five variables (acetowhiteness, margins plus surface, vessel pattern, lesion size, and iodine staining), and had at least one biopsy procedure (either colposcopically directed or by a loop electrical excision procedure). Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratio values, and receiver operating characteristic curves for each clinico-pathological variable to detect low-grade and high-grade squamous intra-epithelial lesions, and any squamous cell abnormality (low-grade + high-grade squamous intra-epithelial lesions) were evaluated individually.ResultsFinal histopathological results of the patients were normal in 53.2% of cases, low-grade lesions in 32.5% of cases, and high-grade lesions in 14.4% of cases. Swede score was ≥8 (median 7.97) for high-grade lesions and ≥5 (median 5.06) for low-grade lesions. The area under the curve values (95% CI) of Swede scores for low-grade and high-grade squamous intra-epithelial lesions, and low-grade + high grade lesions were 0.92, 0.98, and 0.96, respectively. A Swede score cut-off value ≥6 had a sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios of 92%, 98%, 93%, 98%, and 50 (22.6 to 110.8), respectively, for high-grade lesions at the final pathology (P<0.001). One high-risk HPV type (except 16 and 18) was no better than another for calculating the median Swede score during colposcopy (P=0.43).ConclusionsThe Swede score colposcopic scoring system appears to be a useful tool for evaluating atypical cervical cytology in women with high-risk HPV infection other than HPV types 16 and 18.

Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross‐sectional study

“…The evaluating study was performed at a single centre with only seven colposcopists. A recent Turkish clinical study also found Swedescore performance to be superior to that in the current study 5 …”

“…A recent Turkish clinical study also found Swedescore performance to be superior to that in the current study. 5 We found no cutoff level, based on the Swedescore alone, at which the clinician could safely refrain from taking a punch biopsy. The sensitivity was 89% at Swedescore ≥4, entailing a more than 10% risk of CIN2+.…”

“…Previous clinical studies have demonstrated scores below which the probability of CIN2+ is so low (5% or less) that colposcopists could consider refraining from taking biopsies. 1,5,6 In this effectiveness study, we failed to identify any such cutoff level. Even at Swedescore 0-1, 10% had CIN2+, detected with random biopsies.…”

The prevalence and distribution of human papillomavirus in 4267 Turkish women with or without cervical lesions: A hospital‐based study

“…Alan et al detected 34.2% HR‐HPV in their hospital‐based study 21 . The studies attributed their high HPV prevalence to a high rate of abnormal cytology, hospital‐based patients, higher educational status of their patient population, and use of more sensitive HPV detection methods 22–26 . The results of Turkey's HPV screening program, which contains four million women, reported that 4.39% of screened women in the community were HPV DNA positive 16 .…”

“…21 The studies attributed their high HPV prevalence to a high rate of abnormal cytology, hospital-based patients, higher educational status of their patient population, and use of more sensitive HPV detection methods. [22][23][24][25][26] The results of Turkey's HPV screening program, which contains four million women, reported that 4.39% of screened women in the community were HPV DNA positive. 16 This rate is lower than other studies because this result represents community and not only HR-HPV types, but also other HPV types.…”