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Nassiri S, Aminimoghaddam S, Sadaghiani MR, Nikandish M, Jamshidnezhad N, Saffarieh E. Evaluation of the diagnostic accuracy of the cervical biopsy under colposcopic vision. Eur J Transl Myol 2022; 32:10670. [PMID: 36226527 PMCID: PMC9830395 DOI: 10.4081/ejtm.2022.10670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 01/13/2023] Open
Abstract
This study was conducted to evaluate the diagnostic accuracy of the cervical biopsy under colposcopic vision. This retrospective study was performed on 190 women, who were selected from a total of 412 cases referring for colposcopy in one year. All patients underwent colposcopy and loop electrosurgical excision procedure (LEEP). After the investigation of demographic characteristics and data confirmation, colposcopic characteristics were examined. Then, the diagnostic indicators and diagnostic accuracy of the cervical biopsy under colposcopic vision were determined. The mean age of patients was 35.51± 5.91 years. In smokers, the percentage of cancer and CIN3 cases was higher than in normal individuals, and this difference was statistically significant in terms of the frequency of cancerous lesions (P = 0.2). A comparison of colposcopic biopsy with LEEP has shown that the frequency of advanced cases in LEEP has been detected more, and the correlation coefficient (kappa) indicated the weak agreement between the findings of colposcopically directed biopsy (CDB) and LEEP methods. (k = 0.23). The diagnostic accuracy of the cervical biopsy under colposcopic vision for cervical cancer is effectively high. It is recommended that this procedure be performed to diagnose cancerous lesions; however, contrary to what is seen in colposcopy, malignant cases may be spreading and follow-up of patients can affect therapeutic performance.
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Affiliation(s)
- Setare Nassiri
- Endometriosis Research Center, Iran University of Medical Sciences. Tehran, Iran
| | | | - Marjan Ranjbar Sadaghiani
- Shahid AkbarAbadi Clinical Research Development Unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Niousha Jamshidnezhad
- Shahid AkbarAbadi Clinical Research Development Unit (SHACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elham Saffarieh
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Science, Semnan, Iran,Abnormal Uterine Bleeding Research Center, Semnan University of Medical Science, Semnan, Iran. ORCID ID: 0000-0001-9432-7263
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2
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Coronado Martín PJ, González González V, Fasero M. Value of colposcopy with dynamic spectral imaging in the detection and evolution of high-grade cervical lesions. Expert Rev Med Devices 2022; 19:525-532. [PMID: 35858486 DOI: 10.1080/17434440.2022.2104638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To analyze the performance of colposcopy assisted with dynamic spectral imaging (CC-DSI) compared to conventional colposcopy (CC) in diagnosing cervical intraepithelial neoplasia 2+ (CIN2+). METHODS : 973 consecutive women were referred for colposcopy between 2012 and 2016 and were examined simultaneously by CC and CC-DSI; 877 were eligible. Comparisons between CC and CC-DSI were performed against the histological diagnosis performed by either punch biopsy or loop electrosurgical excision procedure (LEEP). RESULTS : In final histology, 494 women had no CIN, 250 had CIN1 and 133 had CIN2+. The sensitivity to identify women with CIN2+ was significantly higher for CC-DSI compared to CC for the entire group and in the subgroup of 675 women referred with ASCUS or LSIL. In women with HPV16/18 infections, the sensitivity of CC increased with the addition of DSI from 53% to 79% (p<0.001). Using a multivariant Cox regression model, CC-DSI was an independent factor for progression of the cervical lesions (HR: 2.29, 95%CI 1.07-4.90). Other predictive factors were the number of sexual partners (HR: 1.05, 95%CI: 1.01-1.09) and anal intercourse (HR: 2.45, 95%CI 1.23-5.02). CONCLUSION CC-DSI improves the ability to detect cervical lesions compared to CC and could help predict their potential to progress.
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Affiliation(s)
- Pluvio J Coronado Martín
- Instituto de Salud de la Mujer. Hospital Clínico San Carlos. IdISSC. Universidad Complutense, Madrid. Spain
| | - Virginia González González
- Instituto de Salud de la Mujer. Hospital Clínico San Carlos. IdISSC. Universidad Complutense, Madrid. Spain
| | - María Fasero
- Servicio de Obstetricia y Ginecología. Hospital Universitario Sanitas La Zarzuela. Universidad Francisco de Victoria, Madrid. Spain
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3
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Seyhan A, Aktürk E. Comparison of Colposcopic Biopsy and Conization Results in Association with Overtreatment or Missed Diagnosis. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2022.47113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Ishikawa M, Nakayama K, Yamashita H, Ishibashi T, Sato S, Kurose S, Sawada K, Sasamori H, Razia S, Ishikawa N, Kyo S. Underdiagnosis of early cervical cancer with an invisible cervical transformation zone in an elderly patient: A case report. Mol Clin Oncol 2021; 15:250. [PMID: 34671469 PMCID: PMC8521384 DOI: 10.3892/mco.2021.2412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Abstract
The treatment of cervical intraepithelial neoplasia (CIN) can result in under- or overtreatment. The current report describes a case of undertreatment of a cervical tumor. A 72-year-old woman was preoperatively diagnosed with CIN3. Following surgery, the final diagnosis of the excised specimen was keratinizing squamous cell carcinoma that measured 2.5 cm in size. The exocervical margin and deep margin were negative. The patient received adjuvant therapy with concurrent chemoradiotherapy and never had disease recurrence. In elderly patients, making an accurate preoperative diagnosis based on specimens from cervical biopsies with or without colposcopy is difficult. MRI may be an accurate preoperative indicator of early cervical tumor, although some studies have demonstrated that MRI has a limitation with respect to its diagnostic ability. Other studies have reported that it is necessary to perform conization prior to hysterectomy. Physicians must reconsider the determined preoperative diagnosis of an early cervical tumor and establish standard guidelines for deciding when to use surgical treatment in elderly patients.
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Affiliation(s)
- Masako Ishikawa
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Kentaro Nakayama
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Hitomi Yamashita
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Tomoka Ishibashi
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Seiya Sato
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Sonomi Kurose
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Kiyoka Sawada
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Hiroki Sasamori
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Sultana Razia
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Noriyoshi Ishikawa
- Department of Organ Pathology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, Shimane University Faculty of Medicine, Izumo, Shimane 6938501, Japan
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Booth BB, Petersen LK, Blaakaer J, Johansen T, Mertz H, Dahl K, Bor P. Accuracy of colposcopy-directed biopsy vs dynamic spectral imaging directed biopsy in correctly identifying the grade of cervical dysplasia in women undergoing conization: A methodological study. Acta Obstet Gynecol Scand 2020; 99:1064-1070. [PMID: 32105344 DOI: 10.1111/aogs.13832] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/05/2020] [Accepted: 02/23/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Dynamic spectral imaging (DSI) colposcopy has previously been found to improve sensitivity of CIN2+ detection. The aim of this study was to compare the histological diagnosis of colposcopic-directed biopsies (CDB) with that of DSI-directed biopsies in women undergoing conization, using the histological diagnosis of the conization specimen as gold standard. MATERIAL AND METHODS Women referred for colposcopy were included in a prospective cohort study at Randers Regional Hospital, Denmark, from January 2016 to February 2019. All women had four cervical punch biopsies taken. The first biopsy was taken from the area that appeared most abnormal by conventional colposcopy (ie, CDB) and the second biopsy from the area that appeared most abnormal using the DSI map. An additional two biopsies were taken either from other visible lesions or as random biopsies. Biopsies were analyzed separately. If any biopsies revealed cervical dysplasia of such a degree that excisional treatment was recommended, the patient was referred for conization. Subsequently, we compared the histological diagnosis of CDB and DSI-directed biopsies with that of the cone biopsy. RESULTS A total of 573 women were enrolled, 170 of which underwent conization. In women with an adequate colposcopy and representative biopsies (n = 124) there was an overall agreement rate between the worst biopsy diagnosis (of any four) and the conization diagnosis in 95.2% (95% CI 89.8-98.2) of women. CDB diagnosis agreed with the cone diagnosis in 80.6% (95% CI 72.6-87.2) of women. DSI-directed biopsy agreed with the cone diagnosis in 83.9% (95% CI 76.2-89.9) of women. The difference in detection rate between the CDB and the DSI-directed biopsy was, however, not significant (P = .54). Taking four biopsies increases the detection rate of cervical dysplasia to 95.2%, which was a significant increase from both CDB alone (P = .0008) and DSI-directed biopsy alone (P = .0053). CONCLUSIONS We found no significant difference in the ability to identify the cervical dysplasia grade between CDB and DSI-directed biopsies. A higher detection rate of cervical dysplasia was achieved with four biopsies than with one CDB biopsy or one DSI-directed biopsy.
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Affiliation(s)
- Berit Bargum Booth
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.,Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lone Kjeld Petersen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,OPEN Open Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
| | - Jan Blaakaer
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tonje Johansen
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Henrik Mertz
- Department of Pathology, Randers Regional Hospital, Randers, Denmark
| | - Katja Dahl
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark
| | - Pinar Bor
- Department of Gynecology and Obstetrics, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Pecourt M, Gondry J, Foulon A, Lanta-Delmas S, Sergent F, Chevreau J. Value of large loop excision of the transformation zone (LLETZ) without histological proof of high-grade cervical intraepithelial lesion: Results of a two-year continuous retrospective study. J Gynecol Obstet Hum Reprod 2019; 49:101621. [PMID: 31430562 DOI: 10.1016/j.jogoh.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/06/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Large loop excision of the transformation zone (LLETZ) conization has been associated with adverse obstetrical outcomes. In an approach to reduce the number of performed LLETZ procedures, we conducted this study to evaluate whether "diagnostic" LLETZ should still be performed, by analyzing their yield in terms of detection (and treatment) of real high-grade squamous intraepithelial lesion (HSIL). METHODS During a two-year study period, all patients who underwent a LLETZ procedure in our institution were retrospectively included. Study participants were divided into two groups according to LLETZ indication: a biopsy-proven HSIL group, and a non-biopsy-proven HSIL group. The results of the final histological examination were recorded, as well as excision margin status and specimen dimensions. RESULTS During the two-year study period, 396 LLETZs were performed, 283 (71%) of which were indicated by biopsy-proven HSIL. In the non-biopsy-proven group, final histology showed 50 cases of HSIL (44%) and 4 cases of carcinoma (3.6%), versus respectively, in the biopsy-proven group, 221 (78%) HSIL and 28 (9.9%) carcinoma (p<0.001). Regarding margin status and specimen dimensions, no intergroup difference was observed between the two groups. CONCLUSION So called "diagnostic" LLETZ allowed the detection of severe cervical lesions in almost half of cases, without increasing specimen dimensions in comparison with classical conization indications. Moreover, they also allowed an efficient treatment as showed by similar margins status. Our results therefore strengthen the idea that "diagnostic" LLETZ, when specific indications are respected, should not be overlooked as a major part of our therapeutic arsenal.
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Affiliation(s)
- Mathilde Pecourt
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Jean Gondry
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Arthur Foulon
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Ségolène Lanta-Delmas
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Fabrice Sergent
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France
| | - Julien Chevreau
- Department of Obstetrics and Gynecology, University Hospital of Amiens, CHU Amiens-Picardie, Avenue Laennec, 80054, Amiens Cedex 1, France.
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Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: a retrospective study. Arch Gynecol Obstet 2018; 299:525-532. [PMID: 30367250 DOI: 10.1007/s00404-018-4953-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 10/20/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Colposcopy-directed biopsy is a cornerstone method for diagnosing cervical intraepithelial neoplasia. The aim of this study was to evaluate the accuracy of colposcopy-directed biopsy in comparison with definitive surgery. METHODS The accuracy of colposcopy-directed biopsy was compared with the final histology in relation to different types of transformation zone (TZ), the patient's age, and the examiner's level of training. RESULTS The overall accuracy of biopsy in comparison with definitive surgery was 71.9% for all entities-benign lesions, low-grade squamous intraepithelial lesions, high-grade squamous intraepithelial lesions (HSILs), and cervical carcinoma-with an underdiagnosis rate of 11.8% and an overdiagnosis rate of 16.5%. The accuracy for detecting HSIL was 88% (401/455), with an underdiagnosis rate of 10.5% and overdiagnosis rate of 1.3%. The accuracy rates for detecting HSIL in women with TZ 1, TZ 2, or TZ 3 were 92.2, 90.5, and 76.5%, respectively. The accuracy rates for detecting HSIL in the different age groups were 93.1% (age 0-34), 83.6% (age 34-55), and 80% (age 55 or older). CONCLUSIONS A combination of the colposcopic findings, cytology, human papillomavirus testing, and colposcopy-directed biopsy is necessary for the correct diagnosis of HSIL. The accuracy rate depends on the TZ and the patient's age. The examiner's level of training does not have any substantial influence on the accuracy.
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8
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Kahramanoglu I, Demirkiran F, Turan H, Bese T, Yilmaz N, Ilvan S, Arvas M. The use of colposcopic punch biopsy in the management of abnormal cervical cytology: a 5–year retrospective audit. J OBSTET GYNAECOL 2018; 39:110-114. [DOI: 10.1080/01443615.2018.1468740] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Fuat Demirkiran
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hasan Turan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tugan Bese
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nevin Yilmaz
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sennur Ilvan
- Department of Pathology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Macit Arvas
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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9
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Analysis of clinical factors correlated with the accuracy of colposcopically directed biopsy. Arch Gynecol Obstet 2017; 296:965-972. [DOI: 10.1007/s00404-017-4500-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/23/2017] [Indexed: 10/18/2022]
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Müller K, Soergel P, Hillemanns P, Jentschke M. Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia. Geburtshilfe Frauenheilkd 2016; 76:182-187. [PMID: 26941452 DOI: 10.1055/s-0041-111504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
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 patient's 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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Affiliation(s)
- K Müller
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover
| | - P Soergel
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover
| | - P Hillemanns
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover
| | - M Jentschke
- Department of Gynaecology and Obstetrics, Hannover Medical School, Hannover
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11
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Bifulco G, De Rosa N, Lavitola G, Piccoli R, Bertrando A, Natella V, Di Carlo C, Insabato L, Nappi C. A prospective randomized study on limits of colposcopy and histology: the skill of colposcopist and colposcopy-guided biopsy in diagnosis of cervical intraepithelial lesions. Infect Agent Cancer 2015; 10:47. [PMID: 26594236 PMCID: PMC4653939 DOI: 10.1186/s13027-015-0042-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/03/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The main objective of our study was to evaluate the colposcopist ability to correctly identify the worst area of a cervical lesion where biopsy should be performed; the secondary objective was to investigate the influence of the colposcopist skill in grading cervical preneoplastic lesions. METHODS 296 patients referred for colposcopy were enrolled in a prospective study. All patients were randomized in two groups: in the first group, "senior group", the colposcopy was performed by an experienced colposcopist; in the second group, "junior group", the colposcopy was performed by a less experienced colposcopist. A detailed colposcopic description, including a grading of the lesion, was completed for each case. During the colposcopic exam patients underwent two direct biopsies; each biopsy was labeled with letter A (suspicious area with most severe grade) or B (suspicious area with less severe grade) according to the judgment of the colposcopist. An experienced pathologist reanalyzed the histological slides, after routine diagnosis. RESULTS The senior group identify the worst area of the cervical lesion in statistical significant higher rates than junior group. Specimen A resulted representative of the higher-grade lesion (A > B) in 73.7 % (N = 28) in senior group and in 48.4 % (N = 15) in junior group; while in 26.3 % (N = 10) the higher-grade lesion corresponded to specimen B (A < B) in senior group and in 51.6 % (N = 16) in junior group (p < .05). CONCLUSION The ability of a colposcopist in grading cervical lesion depends on his experience.
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Affiliation(s)
- Giuseppe Bifulco
- Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy
| | - Nicoletta De Rosa
- Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy
| | - Giada Lavitola
- Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy
| | - Roberto Piccoli
- Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy
| | - Alessandra Bertrando
- Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy
| | - Valentina Natella
- Department of Advanced Biomedical Science, University of Naples "Federico II", Naples, Italy
| | - Costantino Di Carlo
- Department of Neuroscienze e Scienze Riproduttive ed Odontostomatologiche, University of Naples "Federico II", Naples, Italy
| | - Luigi Insabato
- Department of Advanced Biomedical Science, University of Naples "Federico II", Naples, Italy
| | - Carmine Nappi
- Department of Sanità pubblica, University of Naples "Federico II", Naples, Italy
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12
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Garcia FAR, Cornelison T, Nuño T, Greenspan DL, Byron JW, Hsu CH, Alberts DS, Chow HHS. Results of a phase II randomized, double-blind, placebo-controlled trial of Polyphenon E in women with persistent high-risk HPV infection and low-grade cervical intraepithelial neoplasia. Gynecol Oncol 2014; 132:377-82. [PMID: 24388920 PMCID: PMC3955221 DOI: 10.1016/j.ygyno.2013.12.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/22/2013] [Accepted: 12/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In vitro data and pilot data suggest that green tea catechins may possess chemopreventive activity for cervical cancer and precursor lesions. We conducted a randomized, double-blind, placebo-controlled trial of Polyphenon E (decaffeinated and enriched green tea catechin extract) in women with persistent human papillomavirus (HPV) infection and low-grade cervical intraepithelial neoplasia (CIN1) to evaluate the potential of Polyphenon E for cervical cancer prevention. METHODS Ninety-eight eligible women were randomized to receive either Polyphenon E (containing 800 mg epigallocatechin gallate) or placebo once daily for 4 months. The primary study outcome was oncogenic HPV clearance and clearance of CIN1. RESULTS Polyphenon E was shown to be acceptable, safe and well tolerated. There was no difference in the response rate by treatment allocation. Complete response, defined as negative for high-risk HPV and normal histopathology, was noted in 7 (17.1%) and 6 (14.6%) women in the Polyphenon E and placebo arms, respectively. Progression, defined as persistent oncogenic HPV with histopathologic evidence of progression, was more common in the Polyphenon E group than in the placebo group [6 (14.6%) vs. 3 (7.7%)]. CONCLUSION Based on the largest randomized placebo-controlled trial of a green tea extract for HPV related cervical disease, we conclude that 4 months of Polyphenon E intervention did not promote the clearance of persistent high-risk HPV and related CIN1. Further studies may be necessary to better delineate the risk factors for persistent HPV infection and biology of the disease to facilitate the evaluation of chemopreventive strategies.
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Affiliation(s)
- Francisco A R Garcia
- Center of Excellence in Women's Health, The University of Arizona, Tucson, AZ 85724, United States; University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - Terri Cornelison
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, United States
| | - Tomas Nuño
- Center of Excellence in Women's Health, The University of Arizona, Tucson, AZ 85724, United States; University of Arizona Cancer Center, Tucson, AZ 85724, United States.
| | | | - John W Byron
- The Southern Pines Women's Health Center, Southern Pines, NC 28388, United States
| | - Chiu-Hsieh Hsu
- University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - David S Alberts
- University of Arizona Cancer Center, Tucson, AZ 85724, United States
| | - H-H Sherry Chow
- University of Arizona Cancer Center, Tucson, AZ 85724, United States
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13
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Ratnavelu N, Biliatis I, Cross PA, Naik R. Ten-year outcomes of a one-stop colposcopy clinic: a unique service for low grade cytology. Eur J Obstet Gynecol Reprod Biol 2013; 169:287-91. [PMID: 23510950 DOI: 10.1016/j.ejogrb.2013.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 01/28/2013] [Accepted: 02/16/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine patient acceptance of treatment, and treatment default rate, at a one-stop clinic, and to establish the concordance of punch and loop histology for high grade cervical intraepithelial neoplasia (CIN) by date of excisional treatment. STUDY DESIGN Retrospective review of computerised data and clinic files of 2090 women with low grade cytology undergoing cervical punch biopsies between 2001 and 2011 at the colposcopy clinic, Northern Gynaecological Oncology Centre, Gateshead, UK. Punch biopsies were micro-wave processed and reported within 2h, and women were offered immediate loop biopsy if high grade CIN was confirmed. Data were collected regarding patients' choice for immediate or deferred treatment and default rate. Histological outcomes were compared between those undergoing immediate and deferred loop biopsies. RESULTS Of the 360 women (17%) with high grade CIN on punch biopsy, 259 (72%) opted to have immediate loop treatment at the first visit. Of these women, 190 (73%) had high grade CIN on loop histology. Of 97 women (27%) who had deferred loop biopsy after a median of 28 days (range 7-112), 65 (67%) had high grade CIN on loop histology. The default rate at return for treatment appointments was 0% amongst all patients. CONCLUSION This one-stop colposcopy clinic reduces defaulting from treatment. It has proven to be a sustainable service and the majority of women, when given the choice, opt for immediate loop treatment at their first visit.
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Affiliation(s)
- Nithya Ratnavelu
- Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, United Kingdom.
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14
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Underwood M, Arbyn M, Parry-Smith W, De Bellis-Ayres S, Todd R, Redman CWE, Moss EL. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG 2012; 119:1293-301. [DOI: 10.1111/j.1471-0528.2012.03444.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Vargis E, Kanter EM, Majumder SK, Keller MD, Beaven RB, Rao GG, Mahadevan-Jansen A. Effect of normal variations on disease classification of Raman spectra from cervical tissue. Analyst 2011; 136:2981-7. [PMID: 21666910 DOI: 10.1039/c0an01020k] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In this paper, we examine how variations in normal tissue can influence disease classification of Raman spectra. Raman spectra from normal areas may be affected by previous disease or proximity to areas of dysplasia. Spectra were acquired in vivo from 172 patients and classified into five tissue categories: true normal (no history of disease), previous disease normal (history of disease, current normal diagnosis), adjacent normal (disease on cervix, spectra acquired from visually normal area), low grade, and high grade. Taking into account the various "normal" states of the tissue before statistical analysis led to a disease classification accuracy of 97%. These results indicate that abnormal changes significantly affect Raman spectra, even when areas are histopathologically normal. The sensitivity of Raman spectroscopy to subtle biochemical differences must be considered in order to successfully implement it in a clinical setting for diagnosing cervical dysplasia and cancer.
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Affiliation(s)
- Elizabeth Vargis
- Department of Biomedical Engineering, Vanderbilt University, Station B, Box 351631, Nashville, TN 37235, USA
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16
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Zuchna C, Hager M, Tringler B, Georgoulopoulos A, Ciresa-Koenig A, Volgger B, Widschwendter A, Staudach A. Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen. Am J Obstet Gynecol 2010; 203:321.e1-6. [PMID: 20633870 DOI: 10.1016/j.ajog.2010.05.033] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 03/08/2010] [Accepted: 05/19/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We sought to determine the validity of colposcopically directed cervical biopsies as a diagnostic test to define the degree of cervical intraepithelial neoplasia (CIN). STUDY DESIGN In a prospective multicenter trial, patients undergoing excisional procedures of the transformation zone additionally had colposcopy and up to 3 guided cervical biopsies in a single procedure. Cervical biopsies were regarded as a diagnostic test to detect high-grade lesions (CIN 2,3), with the cone specimen as reference standard. RESULTS In all, 488 biopsies were performed in 244 cases, with 2 biopsies done in 192 cases. Cervical biopsies underestimated the severity of lesions in 46.7% of cases. Sensitivity, specificity, and positive and negative predictive values were 66.2% (95% confidence interval [CI], 59.4-72.3), 95.0% (95% CI, 83.5-98.6), 98.5% (95% CI, 94.8-99.6), and 35.5% (95% CI, 27.1-44.9), respectively. CONCLUSION Our data suggest that cytologically suspected high-grade lesions (CIN 2,3) can be confirmed by biopsy in many cases, but they cannot be excluded.
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Affiliation(s)
- Christian Zuchna
- Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.
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17
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Wentzensen N, Zuna RE, Sherman ME, Gold MA, Schiffman M, Dunn ST, Jeronimo J, Zhang R, Walker J, Wang SS. Accuracy of cervical specimens obtained for biomarker studies in women with CIN3. Gynecol Oncol 2009; 115:493-6. [PMID: 19773045 DOI: 10.1016/j.ygyno.2009.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 08/29/2009] [Accepted: 09/01/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We developed a protocol to collect representative cervical specimens based on colposcopic evaluation from women treated with loop electrosurgical excision procedure (LEEP). METHODS We analyzed the histology of biopsies targeting the worst and a normal area on the cervical surface in 74 women referred for LEEP because of cervical intraepithelial neoplasia grade 3 (CIN3) detected in a previous biopsy. Lesions and normal tissue were identified in colposcopy, marked, and removed after LEEP. Cervical cytology specimens collected at the same time were analyzed using Pap cytology and human papillomavirus (HPV) genotyping. RESULTS All but two women had an abnormal colposcopic impression with 59 of 68 (87%) showing an impression of CIN2 or greater. In 19 of 58 (33%) women, the histology result of the frozen specimen targeting the worst lesion was < or =CIN1. In 18 of 46 (40%) women, the histology of the frozen specimen targeting normal tissue was CIN2+. A concordant histology result in specimens targeting the worst lesion was associated with a greater extension of the CIN3 in the LEEP (p trend=0.002) and a HSIL cytology result (p trend=0.02). CONCLUSION It is challenging to sample representative cervical tissue. Even in women with confirmed CIN3, colposcopy performance to identify the worst lesion on the cervix was limited. Correctly identified CIN3s were more likely to be larger lesions that may have a higher risk of progression to cancer.
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Affiliation(s)
- Nicolas Wentzensen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Boulevard, Room 5014, Rockville, MD 20854-7234, USA.
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Woo YL, Sterling J, Damay I, Coleman N, Crawford R, van der Burg SH, Stanley M. Characterising the local immune responses in cervical intraepithelial neoplasia: a cross-sectional and longitudinal analysis. BJOG 2009; 115:1616-21; discussion 1621-2. [PMID: 19035938 DOI: 10.1111/j.1471-0528.2008.01936.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Immunological competence influences the progression of cervical intraepithelial neoplasia (CIN) to invasive cancer. Information on the local immunological changes during the natural course of CIN is central for the development of new therapies. OBJECTIVE This study defines the populations of tissue-infiltrating immune cells in a cross-sectional cohort of different grades of CIN and also in a longitudinal cohort of regressing, persistent and progressing low-grade (LG)-CIN. DESIGN A cohort of 125 women with LG cytological atypia was recruited, of which 64/125 (51%) women with LG-CIN were followed prospectively for 1 year. Paraffin-embedded entry and exit cervical biopsies were used for immunohistochemistry analysis (CD4, CD8, CD56, FOXP3, CD1a and granzyme B). RESULTS At recruitment, 74/125 (59%), 39/125 (31%) and 12/125 (10%) women referred with LG smears had histologically proven LG-CIN, high-grade (HG) and normal biopsies, respectively. Seventeen of 64 (24.6%) women with LG-CIN progressed to HG-CIN within 1 year. In both LG-CIN and HG-CIN, the predominant intraepithelial cell population were cytotoxic T cells, while CD4+ and FOXP3+ T cells predominated the stromal compartment. Women with LG-CIN who later on regressed displayed a significantly higher number of cytotoxic (granzyme B+) cells in their entry samples. In addition, the ratio between CD8+ cells and granzyme B+ cells was close to 1, suggesting that all infiltrating CD8+ T cells were highly active. In contrast, this ratio was three-fold lower in women, in whom the lesions persisted or progressed. CONCLUSIONS This study suggests that the early infiltration of lesions by highly cytotoxic effector cells protects against progression.
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Affiliation(s)
- Y L Woo
- Department of Pathology, University of Cambridge, Cambridge, UK.
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Sadan O, Yarden H, Schejter E, Bilavsky E, Bachar R, Lurie S. Treatment of high-grade squamous intraepithelial lesions: A “see and treat” versus a three-step approach. Eur J Obstet Gynecol Reprod Biol 2007; 131:73-75. [PMID: 16516371 DOI: 10.1016/j.ejogrb.2005.12.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 10/18/2005] [Accepted: 12/29/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The study's subject was to examine the correlation between histologic findings in patients with high-grade squamous intraepithelial lesion (HGSIL) who have undergone loop electrosurgical excisional procedure (LEEP) with and without prior colposcopically directed biopsy. STUDY DESIGN This retrospective study included 144 patients with cytologic HGSIL, of which 62 were treated by a three-step protocol, in which LEEP was performed only if the colposcopically directed cervical biopsies were positive (CIN II-III), and 82 women who were treated by "see and treat" protocol, in which LEEP was immediately performed if colposcopy was suggestive of CIN II or III lesions. RESULTS There were no differences in the final histological findings between the groups. CONCLUSIONS The colposcopically directed LEEP after a HGSIL on PAP-smear may reduce the time interval between diagnosis and treatment with a similar accuracy of diagnosis compared to the standard three-step protocol.
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Affiliation(s)
- Oscar Sadan
- Cervical Clinic, Maccabi Health Services, Tel Aviv, Israel; Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Eduardo Schejter
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Efi Bilavsky
- Sackler School of Medicine, Tel Aviv University, Israel
| | - Rachel Bachar
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
| | - Samuel Lurie
- Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel; Sackler School of Medicine, Tel Aviv University, Israel.
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Collaço LM, de Noronha L, Pinheiro DL, Bleggi-Torres LF. Quality assurance in cervical screening of a high risk population: a study of 65,753 reviewed cases in Parana Screening Program, Brazil. Diagn Cytopathol 2006; 33:441-8. [PMID: 16299748 DOI: 10.1002/dc.20328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Epidemiological data from the Quality Assurance Unit (QAU) of the Cervical Cancer Screening Program of Paraná is discussed. Slides (65,753) reviewed by the QAU, from October 1997 to July 1999, were analyzed. Relations between agreement rate, diagnostic categories, and age groups were tested. The overall agreement rate was 97.04% (kappa +/- 95%, confidence interval = 0.888 +/- 0.003). Low-grade squamous intraepithelial lesion (LSIL) showed its peak prevalence in patients < or = 19 yr (8.3%). High-grade squamous intraepithelial lesion (HSIL) was more common in women between 40 and 49 yr (5.0%). Squamous-cell carcinoma (SCC) was almost exclusively seen in women > or = 40 yr. The lowest agreement rates were seen in adenocarcinoma (54.5%; kappa = 0.667) and LSIL cases (76.3%, kappa = 0.822), and in women < or = 19 yr (95.8%). It was concluded that constant monitoring to assess specific errors allows directed measures. The 10% rescreening model of quality assurance proved to be effective in a low resources setting with a positive overall financial impact.
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Stier E, Freeman-Wang T, Hochberg L, Hummer A, Venkatraman E, Walker P. Using the cone biopsy to compare colposcopy clinics in new york and london. J Low Genit Tract Dis 2005; 8:106-11. [PMID: 15874847 DOI: 10.1097/00128360-200404000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess whether there were significant differences in cytologic and colposcopic assessments associated with conization specimens at a colposcopy clinic in New York compared with a colposcopy clinic in London. MATERIALS AND METHODS A retrospective histopathologic survey of patients evaluated at the Mt. Sinai Hospital Colposcopy Clinic (MSH) in New York City and the Royal Free Hospital Colposcopy Clinic (RFH) in London between January 1, 1997, and December 31, 1998, was reviewed. Study groups included all patients who underwent conization at either clinic. Referral cytologic results, colposcopic findings, and conization histologic results were compared. RESULTS Two hundred three cases from MSH and 457 cases from RFH were reviewed. Most patients undergoing conization in either clinic were referred with Pap smears suggesting high-grade squamous intraepithelial lesions (MSH, 77%; RFH, 77%). Colposcopic biopsy was performed on all patients at MSH. At RFH, colposcopic-directed punch biopsy was not performed on 35% of the patients who would have been treated regardless of biopsy results. There is a significant difference in the distribution of cone histologic diagnosis between the two clinics (p = .02); there are proportionally more women diagnosed with high-grade disease in RFH than in MSH, where there are more normal and low-grade cone histologic results. According to the kappa coefficients, there is only slight agreement between the Pap smear cytologic results and punch biopsy with the conization histologic results for either clinic (MSH, kappa = 0.13; RFH, kappa = 0.19), with the RFH performing slightly better. CONCLUSIONS This study shows exact agreement between cytologic and final conization diagnosis and colposcopic biopsy and final conization as 47% to 64%. Treatment decisions and outcomes are different between the two clinics, with the RFH clinic performing fewer biopsies and having more procedures yielding high-grade disease. Recommendations regarding changing colposcopic practices could best be made after a prospective study.
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Affiliation(s)
- Elizabeth Stier
- Mount Sinai Hospital Colposcopy Clinic (MSH), New York, NY, USA.
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Fambrini M, Penna C, Fallani MG, Marchionni M. Management of cervical intraepithelial neoplasia: the role of biopsy. Int J Gynaecol Obstet 2003; 82:219-20. [PMID: 12873786 DOI: 10.1016/s0020-7292(03)00137-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Fambrini
- Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy.
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Costa S, Nuzzo MD, Rubino A, Rambelli V, Marinelli M, Santini D, Cristiani P, Bucchi L. Independent determinants of inaccuracy of colposcopically directed punch biopsy of the cervix. Gynecol Oncol 2003; 90:57-63. [PMID: 12821342 DOI: 10.1016/s0090-8258(03)00202-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The goal of this study was to determine the clinical factors independently associated with inaccuracy of colposcopically directed punch biopsy in defining extent and severity of epithelial lesions of the cervix. METHODS The study was conducted in a colposcopy clinic devoted to the management of patients with abnormal Pap smear and/or histology diagnosis of cervical intraepithelial neoplasia (CIN) on punch biopsy or endocervical curettage. Seven hundred and thirty-nine patients (median age, 33 years; range, 18-83 years) referred with a punch biopsy diagnosis of CIN2-3 and treated with electrosurgical conization were evaluated. Cone histology diagnosis was assumed to supply the correct diagnosis. Two types of deviation of biopsy diagnosis were considered: (1). unconfirmed high-grade CIN diagnosis, defined as a cone diagnosis of CIN1 and reactive/reparative changes, and (2). nondiagnosis of carcinoma, defined as a cone diagnosis of microinvasive and invasive squamous carcinoma. Multinomial logistic regression analysis was used to assess the determinants of the probability of each type of deviation. RESULTS The probability of unconfirmed high-grade CIN diagnosis (n = 190, 25.7%) was inversely related to number of quadrants involved, severity of referral Pap smear, and grade of biopsy. The probability of nondiagnosis of carcinoma (n = 43, 5.8%) was positively related to patient age, invisibility of the squamocolumnar junction, number of quadrants involved, and cone width. Endo-ectocervical location, cone depth, and time period had no effect whatsoever. CONCLUSIONS The study confirmed previous observations regarding the positive association of patient age and invisibility of squamocolumnar junction with the probability of nondiagnosis of carcinoma. The concomitant positive effects of number of quadrants involved and cone width were suggested to mirror the effect of circumferential development and, respectively, surface area of CIN. Severity of referral Pap smear and grade of biopsy were shown to be inversely related to the probability of a cone diagnosis of CIN1 and benign changes.
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Affiliation(s)
- Silvano Costa
- Department of Obstetrics and Gynecology, University of Bologna, Bologna, Italy
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Barker B, Garcia FAR, Warner J, Lozerski J, Hatch K. Baseline inaccuracy rates for the comparison of cervical biopsy to loop electrosurgical excision histopathologic diagnoses. Am J Obstet Gynecol 2002; 187:349-52. [PMID: 12193923 DOI: 10.1067/mob.2002.123199] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of this study was to quantify the baseline inaccuracies in histopathologic diagnosis between colposcopically directed cervical biopsies and loop electrosurgical excision procedure specimens. STUDY DESIGN A retrospective review was made of cervical biopsies and loop electrosurgical excision procedure pairs (n = 448) that were performed at the University of Arizona between 1992 and 2000. Agreement was assessed by kappa statistics and Spearman rho coefficients. Subgroup analysis was performed (n = 139) to assess pairs with significant inaccuracy between biopsy and loop electrosurgical excision procedure, when these were performed within 28 days of each other. RESULTS Eighty-one percent agreement was found between cervical biopsy and loop electrosurgical excision procedure histopathologic diagnoses, when compared to within 1 degree (kappa, 0.73; P <.0001). A discrepancy that would be attributed to regression or progression was found: mild biopsy (regression, none by definition; progression, 4%), moderate biopsy (regression, 9%; progression, 0%), and severe biopsy (regression, 26%; progression, 0%). CONCLUSION Even when colposcopically directed cervical biopsy correlates strongly with loop electrosurgical excision procedure histopathologic diagnosis, there is a definable percentage of patients for whom there is a discrepancy between these 2 diagnoses. This discrepancy represents an inherent inaccuracy of the diagnostic testing modality and should not be interpreted as progression or regression of disease.
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Affiliation(s)
- Bel Barker
- University of Arizona Health Sciences Center, Tucson, 85724-5078, USA.
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