Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study

Nakamura, Yuko; Matsumoto, Koji; Nishide, Ken; Nozue, Akiko; Shimabukuro, Koji; Endo, Shigekatsu; Nagai, Kimihiro; Oki, Akinori; Minaguchi, Takeo; Morishita, Yukio; Noguchi, Masayuki; Yoshikawa, Hiroyuki

doi:10.1007/s10147-014-0739-6

Cited by 21 publications

(22 citation statements)

References 19 publications

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“…However, this finding is limited by the small number (n = 29) of women whose examination reports included the transformation zone. Other studies have shown a higher benefit of ECC in this patient population [15,26]. The accuracy was higher (69.2%) for the 13 cases investigated preoperatively with ECC alone.…”

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confidence: 57%

“…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].…”

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confidence: 82%

“…The agreement between cytology results and histology results based on biopsy has been reported as 52 % [12], with an agreement of 37 % reported for low-grade squamous epithelial lesions (LSIL) and 76% for high-grade squamous epithelial lesions (HSIL) [13]. The use of ECC has been discussed for those cases where colposcopy findings cannot be adequately assessed, for example women with type 3 transformation zone [14][15][16][17]. This is the context in which the conizations carried out between 2007 and 2013 in the gynecological department of Hannover Medical School were retrospectively reviewed.…”

Section: Accuracy Of Colposcopically Guided Diagnostic Methods For Thmentioning

confidence: 99%

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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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confidence: 57%

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confidence: 82%

Section: Accuracy Of Colposcopically Guided Diagnostic Methods For Thmentioning

confidence: 99%

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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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“…Several studies have reported that colposcopy‐directed biopsies are suboptimal and fail to detect cervical intraepithelial neoplasia grade 2 or worse (CIN2+) in 26–57% of cases . Some authors have found that an increase in the number of biopsies taken from colposcopy‐positive areas improves the detection of high‐grade dysplasia . Others have shown that taking additional biopsies from colposcopy‐negative areas increases the detection of CIN2+ .…”

Section: Introductionmentioning

confidence: 99%

Colposcopy and additive diagnostic value of biopsies from colposcopy‐negative areas to detect cervical dysplasia

Baasland

Hagen

Vogt

et al. 2016

Acta Obstet Gynecol Scand

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IntroductionWe evaluated colposcopy in the routine diagnostic workup of women with abnormal cervical cytology, as well as the diagnostic value of endocervical curettage material and biopsies taken from colposcopy‐positive and colposcopy‐negative quadrants of the cervix.Material and methodsThis cross‐sectional study included 297 nonpregnant women with abnormal cervical cytology and no prior treatment for cervical dysplasia or cancer. All women underwent gynecological examination, colposcopy, endocervical curettage, and had cervical biopsies taken. Colposcopy was considered satisfactory if the squamocolumnar junction was fully visible, and biopsies were taken from all four quadrants of the cervix, regardless of colposcopy results.ResultsIn all, 130 of the women in our study had satisfactory colposcopy results and were diagnosed with cervical intraepithelial neoplasia grade 2 or worse (CIN2+), 61% via a colposcopy‐positive biopsy and 39% via a colposcopy‐negative biopsy. Eighty‐seven of them had positive colposcopy results, but CIN2+ was histologically verified from colposcopy‐positive biopsies in 91% (n = 79) and from colposcopy‐negative biopsies in 9% (n = 8). The remaining 43 women with CIN2+ had negative colposcopy findings, so their diagnosis was verified in colposcopy‐negative biopsies. The sensitivity of colposcopy alone to detect CIN2+ was 61% (95% CI 52–69).ConclusionsIn the present study, colposcopy was not a stand‐alone diagnostic method. Colposcopy‐negative biopsies had a clear additive value, identifying a substantial proportion of women with both positive and negative colposcopy results with treatment‐worthy cervical dysplasia. Endocervical curettage material had little diagnostic value in this study.

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“…Las principales limitaciones durante el proceso de diagnóstico cuando nos enfrentamos a una citología alterada son 1) la interpretación correcta de los hallazgos a la colposcopia y 2) el muestreo apropiado de cualquier lesión sospechosa. De hecho, la ausencia de una lesión que explique una citología alterada aumenta el riesgo de mal diagnóstico y sobre-tratamiento, a pesar de la adición de ECC o el uso de biopsias al azar [10,11]. El estándar de oro para indicar una conización, lo constituye la confirmación histológica de NIE2+.…”

Section: Materials Y Métodosunclassified

El método CONO-UC: un protocolo integrado de toma de decisión y manejo de lesiones pre-invasoras del cuello uterino útil para especialistas jóvenes.

Cuello

Espinosa

Orlandini

et al. 2017

Rev. chil. obstet. ginecol.

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Precis: El método CONO-UC combina una escala que pondera las herramientas diagnósticas y estandariza el tratamiento de las NIE2+, minimizando el riesgo de manejo inadecuado por parte de especialistas jóvenes. RESUMENObjetivos: En la actualidad, existe una alta tasa de sobre-tratamiento de lesiones precursoras cervicales, la cual, en su causalidad, depende de la inexperiencia del operador que toma las decisiones. El objetivo del presente trabajo fue desarrollar un método estandarizado de ponderación/juicio de variables diagnósticas y tratamiento útiles de ser usadas por especialistas jóvenes a fin de minimizar el riesgo de manejo inadecuado.Materiales y métodos: Se incluyeron 471 pacientes referidos por citología anormal y tratados mediante asa de LEEP. Se calcularon la sensibilidad, la especificidad, los valores predictivos y las relaciones de probabilidad para el diagnóstico de NIE2+ para cada uno de los métodos de diagnóstico. A cada residente se le enseñó un protocolo estandarizado de tratamiento mediante asa. Una vez identificados los mejores predictores, se construyó una escala de puntaje que ponderaba las variables y se definió mediante curva ROC el major punto de corte para la predicción de NIE2+. Las diferencias entre los grupos se compararon mediante Chi-cuadrado, ANOVA o t-test. Se construyó curva de fallas mediante el método de 1-Kaplan Meier.Resultados: La prevalencia de NIE2+ en esta cohorte fue 66%. La concordancia entre las pruebas diagnósticas fue baja, teniendo la colposcopia el peor valor predictivo positivo y el mayor riesgo de sobre-tratamiento. Para la escala de puntaje se incluyeron la edad, la citología, la colposcopia (estratificación basada en la extensión de compromiso por cuadrantes), la biopsia por mascada y la concordancia entre pruebas diagnósticas. Un puntaje≥ 9 asociado al uso de un protocolo estandarizado, obtuvo tasas de sobre-tratamiento <15%, de recurrencias de NIE2+ <5% a 5 años y una baja tasa de procedimientos sub-óptimos o con complicaciones (<2 %).Conclusiones: El método CONO-UC al combinar un sistema de puntaje integrado (punto de corte) con un protocolo estandarizado de excisión, permite minimizar el riesgo de sobretratamiento o tratamiento inadecuado, por parte de especialistas jóvenes, de lesiones preinvasoras del cuello uterino, reduciendo además el número de procedimientos indicados innecesariamente y manteniendo una alta tasa de éxito terapéutico.PALABRAS CLAVE: colposcopia, procedimiento de escisión electroquirúrgica (LEEP), puntaje, neoplasia intraepitelial cervical (NIE), conización.

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Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study

Abstract: Our data suggest that at least two colposcopy-directed biopsies should be taken for histological diagnosis. Random biopsies and ECC are recommended for special populations.

Cited by 21 publications

References 19 publications

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

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

Colposcopy and additive diagnostic value of biopsies from colposcopy‐negative areas to detect cervical dysplasia

El método CONO-UC: un protocolo integrado de toma de decisión y manejo de lesiones pre-invasoras del cuello uterino útil para especialistas jóvenes.

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