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Does experience in colposcopy improve identification of high grade abnormalities?

OBJECTIVE

This study investigates whether experience in colposcopy improves identification of high grade abnormalities. The sensitivity and positive predictive value (PPV) of colposcopy in identifying high grade intra-epithelial lesions (HSIL) performed by relatively inexperienced as compared to experienced colposcopists are evaluated.

STUDY DESIGN

Of 18,421 colposcopies performed at the Royal Women's Hospital, Melbourne, Australia, between 1999 and 2004 by 5 senior and 11 junior colposcopists, the colposcopic impression was correlated with the histopathology result of the biopsy taken at 6020 colposcopies, with respect to the experience of the colposcopist.

RESULTS

Colposcopy had a 60% sensitivity and 60% PPV in identifying HSIL in this study. In case of a high-grade referral smear the sensitivity and PPV in identifying HSIL were, respectively 76% and 73%, compared with 26% and 48% in case of a low-grade referral smear, no difference in overall colposcopic performance between experienced and inexperienced colposcopists was observed. However, the sensitivity of identifying HSIL was significantly higher with inexperienced colposcopists, and the PPV was significantly higher with experienced colposcopists.

CONCLUSION

In this study experience did not improve colposcopic performance, but differences in colposcopic strategy between the two groups were noted. The rather low overall sensitivity and PPV of colposcopy in identifying HSIL, especially in case of a low-grade referral smear, indicate that the role of colposcopy in the detection and treatment of cervical abnormalities is to assess size, site, and extent of an abnormality, rather than to assess the severity of this abnormality. Histology must remain the gold standard for treatment.

2006 consensus guidelines for the management of women with abnormal cervical screening tests

OBJECTIVE

To provide revised evidence-based consensus guidelines for managing women with abnormal cervical cancer screening test results.

PARTICIPANTS

A group of 146 experts, including representatives from 29 professional organizations, federal agencies, and national and international health organizations, met in Bethesda, MD, September 18-19, 2006, to develop the guidelines. MAJOR CHANGES IN GUIDELINES: The core recommendations for managing women with atypical squamous cells of undetermined significance and low-grade squamous intraepithelial lesions were changed minimally. Postcolposcopy management for women with these cytological abnormalities is now identical. Management recommendations for these conditions did change for "special populations," such as adolescents for whom a more conservative approach incorporating cytological follow-up for 2 years was approved. Core recommendations for managing women with high-grade squamous intraepithelial lesions and atypical glandular cells also underwent only minor modifications. More emphasis is placed on immediate "screen-and-treat" approaches when managing women with high-grade squamous intraepithelial lesion. Testing for high-risk human papillomavirus DNA is incorporated into the management of women with atypical glandular cells after their initial evaluation with colposcopy and endometrial sampling. The 2004 Interim Guidance for the use of human papillomavirus DNA testing as an adjunct to cervical cytology for screening in women 30 years and older was formally adopted with only very minor modifications.

CONCLUSIONS

The 2006 Consensus Guidelines reflect recent data from large clinical trials and advances in technology and are designed to assist clinicians of all subspecialties.

Increased detection of high-grade cervical intraepithelial neoplasia utilizing an optical detection system as an adjunct to colposcopy

OBJECTIVE

To evaluate the impact of using a novel optical detection system (ODS) as an adjunct to colposcopy.

METHODS

A multicenter internally controlled trial designed to evaluate the performance of an ODS system (LUMA MediSpectra, Lexington, MA) used as an adjunct to colposcopy among women referred for the evaluation of an abnormal cervical cytology result was conducted at 7 colposcopy clinics in the United States and enrolled 227 women. After exclusions, 193 women remained in the analysis. The main study outcomes were incremental increases in true positives (CIN 2,3 and cancer, or CIN 2+) and false positives (women with additional cervical biopsies not found to be CIN 2+).

RESULTS

Initial colposcopy identified 41 cases of CIN 2+ for a true positive (TP) rate of 21.2%. Adjunctive use of ODS identified an additional 9 cases of CIN 2+ which corresponds to an incremental ODS TP rate of 4.7% (95% CI 2.2% to 8.7%). Adjunctive use of ODS therefore resulted in a 22.0% (95% CI 6.1% to 37.8%) relative gain in the number of women with CIN 2+ compared to colposcopy alone. The false positive (FP) rate for initial colposcopy was 51.8% (100 of 193 women). An additional 35 subjects had an ODS-directed biopsy that was not diagnosed as CIN 2+, yielding an incremental FP rate of 18.1% (95% CI 13.0% to 24.3%).

CONCLUSIONS

Adjunctive use of ODS with colposcopy provides a significant increase in the detection of CIN 2+ in women referred for the evaluation of abnormal cytology results.