Endocervicoscopy and Biopsy to Detect Cervical Intraepithelial Squamous Neoplasia in Nonvisible Squamocolumnar Junction With Unsatisfactory Colposcopy: A Pilot Study

Abstract

The aim of this study was to investigate the practical utility of endocervicoscopy and targeted biopsy in high-risk human papilloma virus–positive women with abnormal squamous cells on cervical cytology and unsatisfactory colposcopy with nonvisible squamocolumnar junction. Seventy-seven high-risk human papilloma virus–positive patients with abnormal cervical cytology for squamous cells bearing type 3 transformation zone were enrolled. Endoscopic examination of the endocervical epithelium, with office-based continuous-flow hysteroscopy after application of acetic acid 5%, followed by targeted biopsies and consequent large loop excision of the transformation zone was carried out. Sensitivity, specificity, positive predictive value and negative predictive value of endocervicoscopy, and orientated biopsy were confronted with the results of large loop excision of the transformation zone (referral test). The sensitivity and specificity of endocervicoscopy and orientated biopsy for low-grade cervical intraepithelial neoplasia were 53% and 81%, respectively, while the sensitivity and specificity for high-grade cervical intraepithelial neoplasia were 64% and 47%, respectively. The positive predictive value for low-grade cervical intraepithelial neoplasia was 64% and for high-grade cervical intraepithelial neoplasia was 88%. The negative predictive value for low-grade cervical intraepithelial neoplasia was 87% and for high-grade cervical intraepithelial neoplasia was 41%. Endocervicoscopy is a safe, office-based technique. It is a reliable method to detect the transformation zone in patients with type 3 transformation zone and unsatisfactory colposcopy. It potentially allows target biopsy of the transformation zone but presents a relatively low specificity/negative predictive value to predict high-grade cervical intraepithelial neoplasia, thus negative biopsy results should be interpreted with caution.

Office cervicoscopy versus stationary colposcopy in suspicious cervix: A randomized controlled trial

“…[25] Endocervicoscopy was successfully performed on 77 women having a Type 3 TZ with orientated punch biopsy and consequent LLETZ. [27]…”

Good performance of p16/Ki‐67 dual‐stain cytology for detection and post‐treatment surveillance of high‐grade CIN/VAIN in a prospective, cross‐sectional study

“…Management difficulties arise when the TZ is entirely within the endocervical canal. This is known as a transformation zone type 3 (TZ3) 7 . Twenty percent of colposcopic assessments are inadequate due to TZ3 22 .…”

“…For instance, when patients have a positive hrHPV result but a low‐grade squamous abnormality on cytology, subjecting these patients to colposcopy often turns out to be unnecessary, as many of them show only benign or low‐grade dysplastic changes of the cervix on histology. On the other hand, for hrHPV positive women bearing with type 3 transformation zone (TZ) and nonvisible squamocolumnar junction (SCJ), colposcopy might be unsatisfactory or inconclusive 7,8 . Therefore, there is a need for a test to better triage women who are hrHPV positive and have low‐grade cytology results to reduce the unnecessary application of colposcopy.…”

Sequential Application of Lugol’s Iodine Test after Acetic Acid for Detecting Cervical Dysplasia: A Prospective Cohort Study

“…It is of note that within the context of this study, we did not routinely perform endocervicoscopy, a technique used to hysteroscopically visualize the endocervix in women with abnormal cervical cytology and a type 3 transformation zone. This technique uses endoscopic examination of the endocervical epithelium with office-based continuous-flow hysteroscopy after application of acetic acid 5%, followed by targeted biopsies [27][28][29]. This has to be kept in mind when extrapolating the results of our study to local practice practicing routine endocervicoscopy.…”