Repeating cytology at initial colposcopy does not improve detection of high-grade abnormalities: A retrospective cohort study of 6595 women

Bhaumik, Jaydip; Beer, Helen; Leeson, Simon

doi:10.1016/j.ygyno.2005.10.017

Cited by 6 publications

(6 citation statements)

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“…9,13,15 Dolman et al, 9 in a study conducted in Australia, reported that repeat cytology would have altered patient management in 2% of women referred with LSIL and in 7% of those referred with a diagnosis of HSIL. Rieck et al, 15 in a study conducted in England, reported that management could have been different in 8.6% of women enrolled in a study in which it was concluded that repeating cytology at the time of colposcopy does not improve the detection of high-grade abnormalities. That study also showed that in 6.4% of women with a high-grade lesion detected at referral cytology in whom repeat cytology and final diagnosis indicated low-grade findings, management of their high-grade smear may have been altered by a repeat smear taken at colposcopy.…”

Section: Discussionmentioning

confidence: 99%

“…7,10 On the other hand, recent studies suggest that the value of repeating a cervical smear at the time of colposcopy may be low, with sensitivity ranging from 25 to 57%. [11][12][13][14][15] Possible mechanisms that justify this low sensitivity include recent removal of the neoplastic cells and the fact that, after the initial scraping, the abnormal cells are not so easily exfoliated. 4,11 However, other studies have reported sensitivity above 70%.…”

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confidence: 99%

“…4,11 However, other studies have reported sensitivity above 70%. 15 Hypothetically, repeat cytology performed at the time of colposcopy may be clinically significant when results indicate a grade higher than that found by colposcopyguided biopsy, hence raising the suspicion that the lesion may be inside the cervical canal. 9 Therefore, a repeat cervical smear may lead to a change in clinical management.…”

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confidence: 99%

“…9 Therefore, a repeat cervical smear may lead to a change in clinical management. 9,15 Consequently, this study has been designed to analyze the value of repeat cytology at the time of colposcopy for the detection of high-grade, preinvasive, or invasive disease after referral due to abnormal cytology findings.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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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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“…These results show a superiority of the colposcopy with biopsy in the detection of the LIEHG. However, these results should be viewed with caution, since it is well established that the reference of the precancerous and cancerous lesions diagnostic test remains [10] histology. In this study it was trained colposcopists, the results should not be generalized.…”

Section: ) Explorationmentioning

confidence: 97%

Colposcopy at the University Hospital in Conakry: Role of Colposcopy in Screening and/or Diagnosis of Cervical Cancer in the UTH University Teaching Hospital of Conakry

Soumah¹,

Bah²,

Bah³

et al. 2018

OJOG

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Objective: This study was conducted to evaluate the role of colposcopy in the screening of cervical cancer at the UTH in Conakry. Material and Methods: We conducted a descriptive study on over a period of 18 months of from the 1 July 2004 to December 31, 2005 in the CHU of Conakry Any women aged from 25 to 65 years old who has agreed to the screening of cervical cancer by colposcopy was included. Statistical tests of sensitivity, specificity, and predictive values positive and negative were computed directly and compare among all participants. Results: During the study period, we included a total of 9339 women. For all precancerous and cancerous lesions, sensitivity and specificity were 93% and 64% respectively. With a positive predictive value of 46% and the negative predictive value of 90%, low and high grade precancerous lesions were found with: a sensitivity of 91%, the specificity of 64%. The positive predictive value of 37%, and the negative predictive value of 91% were estimed. Intra epithelial lesions (LIEBG) low-grade squamous sensitivity was 94%, specificity of 62%, the positive predictive value of 31%, the negative predictive value of 95%. For lesions intra epithelial highgrade squamous (LIEHG), the sensitivity was 85%, 10%, the positive predictive value of 74% specificity, negative predictive value of 95%. Conclusion: Colposcopy is a reference method of detection of precancerous lesions of the cervix to promote cancer.

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Colposcopy

Turenne-Kolpan

2010

Primary Care Procedures in Women's Health

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Repeating cytology at initial colposcopy does not improve detection of high-grade abnormalities: A retrospective cohort study of 6595 women

Cited by 6 publications

References 12 publications

Usefulness of repeat cytology at the time of first colposcopy

Usefulness of repeat cytology at the time of first colposcopy

Colposcopy at the University Hospital in Conakry: Role of Colposcopy in Screening and/or Diagnosis of Cervical Cancer in the UTH University Teaching Hospital of Conakry

Colposcopy

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