Outcome analysis of 4 years’ follow‐up of patients referred for colposcopy with one smear showing mild dyskaryosis

Ahmed, Aamir; Goumalatsos, G.; Akbar, Nuzhat; Lawton, Frank; Savvas, M.

doi:10.1111/j.1365-2303.2007.00478.x

Cited by 6 publications

(2 citation statements)

References 47 publications

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“…Our reanalysis of the accuracy of diagnostic colposcopy showed that colposcopy is less sensitive than estimated in previous studies. However, our results are within the ranges of other estimates in the literature [ 2 – 10 , 13 , 14 ]. In agreement with recent studies showing that colposcopy performs well as an adjunct to biopsy, our findings support the use of colposcopy as a diagnostic aid following an abnormal Papanicolaou smear result and in guiding biopsy [ 7 , 15 , 16 ].…”

Section: Discussionsupporting

confidence: 90%

“…In Vancouver, patients diagnosed with LSIL on the basis of a Papanicolaou smear are treated as the normal patient group and placed on a “watchful waiting” regimen, and only patients diagnosed with HSIL on the basis of a Papanicolaou smear are evaluated. Some studies have shown that this practice may prevent overtreatment [ 13 ] while others suggest that sending LSIL patients for immediate colposcopy may avoid the anxiety associated with repeated Papanicolaou smears [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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An Alternative Approach for Estimating the Accuracy of Colposcopy in Detecting Cervical Precancer

et al. 2015

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IntroductionSince colposcopy helps to detect cervical cancer in its precancerous stages, as new strategies and technologies are developed for the clinical management of cervical neoplasia, precisely determining the accuracy of colposcopy is important for characterizing its continued role. Our objective was to employ a more precise methodology to estimate of the accuracy of colposcopy to better reflect clinical practice.Study designFor each patient, we compared the worst histology result among colposcopically positive sites to the worst histology result among all sites biopsied, thereby more accurately determining the number of patients that would have been underdiagnosed by colposcopy than previously estimated.Materials and MethodsWe utilized data from a clinical trial in which 850 diagnostic patients had been enrolled. Seven hundred and ninety-eight of the 850 patients had been examined by colposcopy, and biopsy samples were taken at colposcopically normal and abnormal sites. Our endpoints of interest were the percentages of patients underdiagnosed, and sensitivity and specificity of colposcopy.ResultsWith the threshold of low-grade squamous intraepithelial lesions for positive colposcopy and histology diagnoses, the sensitivity of colposcopy decreased from our previous assessment of 87.0% to 74.0%, while specificity remained the same. The drop in sensitivity was the result of histologically positive sites that were diagnosed as negative by colposcopy. Thus, 28.4% of the 798 patients in this diagnostic group would have had their condition underdiagnosed by colposcopy in the clinic.ConclusionsIn utilizing biopsies at multiple sites of the cervix, we present a more precise methodology for determining the accuracy of colposcopy. The true accuracy of colposcopy is lower than previously estimated. Nevertheless, our results reinforce previous conclusions that colposcopy has an important role in the diagnosis of cervical precancer.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

An Alternative Approach for Estimating the Accuracy of Colposcopy in Detecting Cervical Precancer

et al. 2015

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Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions

Arbyn

Roelens

Simoens

et al. 2013

Cochrane Database of Systematic Reviews

110

156

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Usefulness of repeat cytology at the time of first colposcopy

Alves

Rabelo-Santos

Ribeiro

et al. 2008

Diagnostic Cytopathology

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The value of repeat cytology in the detection of high-grade preinvasive or invasive disease was analyzed at the time of colposcopy in cases of patients with abnormal referral cytology. A series of 136 patients with squamous abnormalities in their referral cytology, who had undergone repeat cytology and for whom outcome had been established, were included in the study. Final diagnosis consisted of 27 negative results (20%), 37 cases of CIN1 (27%), 31 CIN2 (23%), 39 CIN3 (29%), and 2 (1%) cases of squamous cell carcinoma (SCC). Referral and repeat cytology suggestive of atypical squamous cells cannot exclude high-grade squamous intraepithelial lesion (ASC-H), high-grade squamous intraepithelial lesion (HSIL) were findings significantly associated with a final diagnosis of CIN2 or worse. Sensitivity and positive predictive value of repeat cytology for the histological diagnosis of significant histological neoplasia (CIN2 or worse) were 81.9% and 77.6%, respectively. In women with referral cytology findings of atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion (ASC-US/ LSIL), repeat cytology was suggestive of HSIL in 20% of cases (11/ 54), and in 4% (2/54) biopsy was negative or CIN1, and the final diagnosis established by LLETZ was CIN3. Eight cases (10%) of HSIL in referral and repeat cytology in which biopsies were negative or insufficient were diagnosed as CIN3 or worse in the final diagnosis. Repeat cytology would have changed therapeutic management in 4 and 10%, respectively, of patients included as ASC-US/ LSIL and ASC-H/HSIL in referral cytology. Diagn. Cytopathol. 2009;37:68-73. ' 2008 Wiley-Liss, Inc.Key Words: cytology; colposcopy; CIN; outcome Conventional cervical cytology is the worldwide screening test for cervical cancer and its accuracy has been discussed recently. The levels of sensitivity and specificity of cervical cytology vary greatly. A meta-analysis on the accuracy of cervical cytology estimates sensitivity and specificity ranging from 11 to 99% and 14 to 97%, respectively. 1,2 New technologies such as liquid-based cytology (LBC) and human papilloma virus (HPV) testing have been introduced into cervical cancer screening. However, there is continuous debate about whether society's limited resources are better spent on reaching the underserved rather than on these technologies. 3 Davey et al. 4 in a meta-analysis did not show evidence that LBC reduced the proportion of unsatisfactory slides or detected more high-grade lesions in high-quality studies than in conventional cytology. This review does not lend support to claims of better performance by liquidbased cytology. In addition, although HPV-DNA testing had higher sensitivity for detecting high-grade squamous intraepithelial lesions, its specificity is lower than that of cytology, particularly in younger women, and this represents an important restriction to the adoption of this technique as a single screening tool. 2,5 Performing a repeat cervical smear just prior to colposcopy is a common pr...

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Outcome analysis of 4 years’ follow‐up of patients referred for colposcopy with one smear showing mild dyskaryosis

Cited by 6 publications

References 47 publications

An Alternative Approach for Estimating the Accuracy of Colposcopy in Detecting Cervical Precancer

An Alternative Approach for Estimating the Accuracy of Colposcopy in Detecting Cervical Precancer

Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions

Usefulness of repeat cytology at the time of first colposcopy

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