Diagnostic Three Slides Pap Test Compared to Punch Biopsy and Endocervical Curettage in Confirmed HSIL+ Diagnosis

Abstract

Objective: The aim of the study was to evaluate the accuracy of the diagnostic Pap test (DPT) on three slides and punch biopsy and endocervical curettage (PB/ECC) compared with the final biopsy material in the detection of high-grade squamous intraepithelial lesion (HSIL). Materials and methods: Patients treated with conization after previous DPT and PB/ECC were analyzed. The findings of the DPT and PB/ECC as well as of the endocervical brush cytology and ECC were compared with the final conus histology. Results: 150 patients were analyzed, and final histology verified 145 cases of HSIL and 3 cancers. The percentage of confirmed HSIL cytology was 97%, while for PB/ECC it was 79% with 30/145 false negative results. The correlation between Pap test and PB/ECC showed that the diagnostic accuracy of DPT is significantly higher (p < 0.0001). Endocervical brush cytology confirmed HSIL+ in the endocervical canal in 83% and ECC in 35% of cases (p < 0.0001). Conclusion: The DPT on three slides enables better detection of HSIL compared to PB/ECC, particularly for lesions localized in the endocervical canal sampled with a cytobrush. A high quality DPT could represent a surrogate for PB/ECC and open the possibility of direct access to therapeutic procedure.

Endocervical curettage for diagnosing high-grade squamous intraepithelial lesions or worse in women with type 3 transformation zone lesions: a retrospective, observational study

“…Maximiliano et al attempted to overcome the drawbacks associated with the sparseness of ECC tissue using cell concentration methods, which may be a suitable strategy for qualitative improvement of the sensitivity of ECC and its diagnostic value [ 27 ]. Furthermore, Rubesa-Mihaljevic et al found ECC sensitivity was higher for samples with abundant materials compared to samples with relatively few [ 28 ]. Uses of inexpensive and less painful sampling instruments to increase the rate of satisfactory specimen and reduce the reliance on senior physicians are additional ways of increasing patients’ compliance with procedures and improving lesion detection rates [ 29 ].…”

Additional role of ECC in the detection and treatment of cervical HSIL

“…In one prospective study of 1,299 patients, there was a 72.4% diagnostic agreement between colposcopic targeted biopsy combined with ECC and specimens after cervical coning ( 10 ). In another study evaluating 150 patients with HSIL+ using the pathological results of postoperative conical specimens as the final criterion, colposcopic targeted biopsy combined with ECC had a 79% coincidence rate for a cervical HSIL+ diagnosis ( 11 ). In this current study, the diagnostic agreement rate of ECC combined with colposcopic targeted biopsy was higher than that of colposcopic targeted biopsy alone (72.43% vs. 67.54%).…”

Endocervical sampling in women with suspected cervical neoplasia: a systematic review and meta-analysis of diagnostic test accuracy studies

“…Yet, because of few inadequate samples in the 2 studies and because the rest of the included 5 studies excluded inadequate samples, this is not likely to be the reason for the diverging sensitivities of EB and ECC. In light of these findings, a recent study by Mihaljevic et al 31 has reported in a subanalysis that ECC samples with abundant material had higher sensitivity than those with scant material. We would have liked to have included this study, but some errors and inconsistencies were found in their 2Â2 tables, and the corresponding author did not reply to our e-mail.…”