Multiple Biopsies and Detection of Cervical Cancer Precursors at Colposcopy

Wentzensen, Nicolas; Walker, Joan L.; Gold, Michael A.; Smith, Katie; Zuna, Rosemary E.; Mathews, Cara; Dunn, S. Terence; Zhang, Roy; Moxley, Katherine M.; Bishop, Erin; Tenney, Meaghan; Nugent, E.; Graubard, Barry I.; Wacholder, Sholom; Schiffman, Mark

doi:10.1200/jco.2014.55.9948

Cited by 176 publications

(213 citation statements)

References 25 publications

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“…Moreover, in this study Colposcopy showed high sensitivity (75%), specificity (99%), and excellent positive (94%) and negative (96%) predictive values. This come accordance with results of Wentzensen et al showing high sensitivity (74-87%), specificity (56-68%), and good positive and negative predictive value especially when multiple colposcopic directed biopies obtained and recommend use of colposcopy as useful tool in diagnosis and management of SILs (28) .…”

Section: Discussion:-supporting

confidence: 79%

Abnormal Pap Tests in Systemic Lupus Erythematosis: A Cytopathological and Human Papillomavirus Testing Study.

Girbash¹,

Atta²,

Fahmy³

et al. 2016

IJAR

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Objectives: the frequency of cervical squamous intra-epithelial lesions (SIL) in women with systemic lupus erythematosus (SLE), and the association between clinical parameters, use of immunosuppressant agents, human papillomavirus (HPV) infection, colposcopy, and development of SIL in SLE.Methods: A retrospective case control study conducted in 150 women constituted the study group with confirmed diagnosis of SLE. The enrolled patients divided into study group (no.28) with abnormal pap smears and reference group (no.122) with normal pap smears. All patients subjected to clinical evaluation, colposcopy, directed biopsies, and HPV-ISH testing. All participants reassessed every 6 months for 2 years.Results: mean patient age with abnormal pap smears was 44.8(P = 0.74) years with mean SLE disease duration was 9.3±7.1 years. There was past history of cervical lesions where it was positive in 89.3% (P = 0.001). SLE patients with abnormal pap smears showed significant difference regarding nephritis (P = 0.001) and high titers of Anti-double stranded DNA (P = 0.001) and Antiphospholipid antibodies (P = 0.012). SLEDAI, SDI, and immunosuppressant agent usage found significantly different among patients with abnormal pap smears. HPV Infection found significantly important (P = 0.001) when the infection was high-risk HPV, multiple HPV, or persistent HPV infection among patients with abnormal pap smears. On comparison with cytology, colposcopy, HPV-ISH results, the best sensitivity was with the use of HPV-ISH (90%) then with colposcopy (75%). In addition, the best specificity was with the use of colposcopy (99%). The highest positive predictive value was with colposcopy (94%) and the highest negative predictive value was with HPV-ISH assay (98%). Conclusion:Patients with SLE had higher risk for HPV infection and cervical dysplasia than the general population. Thus, gynecological visits at shorter intervals (3-6 months) recommended for those patients. The use of colposcopy is useful tool in areas where the screening of HPV is not available.

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Section: Discussion:-supporting

confidence: 79%

Abnormal Pap Tests in Systemic Lupus Erythematosis: A Cytopathological and Human Papillomavirus Testing Study.

Girbash¹,

Atta²,

Fahmy³

et al. 2016

IJAR

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“…This assumption is also borne out by other studies which have showed increased sensitivity when several biopsies are taken compared to when only one biopsy is obtained [15]. The highest sensitivity for the detection of high-grade dysplasia as reported in a study by Wentzensen et al was 95.6 % after taking three biopsies; the figure dropped to 85.6 % after two biopsies and to 60.6 % if only one biopsy was taken [20]. Another study only showed an increase in sensitivity after taking a second biopsy, with no further improvements reported after taking a third biopsy [6].…”

mentioning

confidence: 49%

Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Müller

Soergel

Hillemanns

et al. 2016

Geburtshilfe Frauenheilkd

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!Introduction: Many factors can affect the accuracy of colposcopically guided biopsy, endocervical curettage (ECC) and differential cytology, all of which are standard, minimally invasive procedures used to detect cervical intraepithelial neoplasia. Method: All conizations carried out between 2007 and 2013 in the gynecological department of Hannover Medical School were retrospectively reviewed. The agreement between colposcopic diagnosis and histology was evaluated retrospectively. The analysis included 593 complete datasets out of a total of 717 cases treated. Results: The overall agreement was 85.5 %; the accuracy was significantly higher (p = 0.029) when three biopsy specimens were taken rather than just one. The agreement between diagnosis and histological findings from conization was highest for women < 30 years (90.7%) and lowest for women > 50 years (72.1%; p = 0.008). The agreement between preoperative differential cytology and histology results after conization was 86.7 % and improved as patient age increased (p = 0.035). The agreement between ECC findings and the results of conization was only 49.1 % irrespective of patient age, transformation zone or the patientʼs menopausal status. Conclusion: The accuracy of colposcopically guided biopsy appears to increase when three biopsy specimens are taken and is particularly high for younger patients. Differential cytology was also found to be highly accurate and is particularly useful for patients aged more than 50 years. The accuracy of ECC was significantly lower; however ECC can provide important additional information in selected cases.

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“…As identified by others, both random and directed additional biopsies increase the sensitivity of Extra biopsies during colposcopy 7 traditional colposcopy. [4][5][6][7][8] What is not clear is whether the additional cases identified represent clinically significant disease. We agree with Huh et al that colposcopy misses clinically significant (as well as clinically insignificant) disease.…”

Section: Discussionmentioning

confidence: 99%

“…4 Others have found the accuracy of colposcopically directed biopsy to be higher with 3 biopsies (up to 95.6%). 5,6 Random biopsies at the squamocolumnar junction when no lesions are visible have been shown to detect 19.7% of CIN2+ disease with one biopsy, 7 and 25.7% of CIN3+ with four biopsies (one in each cervical quadrant). 8 Further techniques to improve the sensitivity of cervical high-grade disease and cancer detection include the use of digital imaging technologies.…”

Section: Extra Biopsies During Colposcopymentioning

confidence: 99%

Utility of extra biopsies during colposcopy: experience with a cervical imaging system at an academic center

Richards

Stockdale

2017

Proc Obstet Gynecol

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Multiple Biopsies and Detection of Cervical Cancer Precursors at Colposcopy

Abstract: Collection of additional lesion-directed biopsies during colposcopy increased detection of histologic HSIL, regardless of patient characteristics. Taking additional biopsies when multiple lesions are present should become the standard practice of colposcopic biopsy.

Cited by 176 publications

References 25 publications

Abnormal Pap Tests in Systemic Lupus Erythematosis: A Cytopathological and Human Papillomavirus Testing Study.

Abnormal Pap Tests in Systemic Lupus Erythematosis: A Cytopathological and Human Papillomavirus Testing Study.

Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Utility of extra biopsies during colposcopy: experience with a cervical imaging system at an academic center

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