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Akgor U, Ozgul N, Gunes AC, Turkyılmaz M, Gultekin M. Evaluation of Endocervical Curettage in Colposcopy in the Turkish Cervical Cancer Screening Program. J Clin Med 2024; 13:4417. [PMID: 39124684 PMCID: PMC11313522 DOI: 10.3390/jcm13154417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/21/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: To investigate the risk factors for CIN2+ lesions (cervical intraepithelial neoplasia 3 or worse) in endocervical curettage (ECC) and to evaluate the relationship between the addition of ECC to punch biopsy in terms of the yield of CIN2+ lesions. Methods: Between February 2018 and 2019, data on colposcopy results from 11,944 patients were gathered from the Cancer Department of the Turkish Ministry of Health across the country. A total of 6370 women whom were referred to colposcopy were included in this study. Risk factors were identified using both univariate and multivariate logistic analyses. Results: The median age was 42 years old (range, 30-65). ASC-H (atypical squamous cells-suggestive of high-grade squamous intraepithelial lesion)/HSIL (high-grade intraepithelial lesion) cytology (OR 7.648 95% CI (3.933-14.871)) and HPV (human papillomavirus)-16/18 infection (OR 2.541 95% CI (1.788-3.611)) were identified as risk factors for having CIN2+ lesions. CIN2+ diagnostic yield by ECC is only 1.2% all patients. CIN2+ diagnostic yield by punch biopsy and ECC are 9.7% and 6% of patients, respectively. A higher CIN2+ yield by ECC was observed with increasing age. Among cytology groups, ASC-H/HSIL has highest CIN2+ yield by ECC. Finally, in patients with incomplete visualization of the squamocolumnar junction (SCJ), ECC yields approximately twice as many CIN2+ lesions. Conclusions: ECC should be considered in cases of advanced patient age and in situations where the SCJ is not routinely visualized. In addition, evaluation of the endocervical canal is necessary in HPV-positive cases infected with HPV-16/18 types and in cases infected with HPV of any type but with cytological abnormalities.
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Affiliation(s)
- Utku Akgor
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - Nejat Ozgul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
| | - Ali Can Gunes
- Department of Obstetrics and Gynecology, Mamak State Hospital, Ankara 06320, Turkey;
| | - Murat Turkyılmaz
- Department of Cancer Control, Turkish Ministry of Health, Public Health Institute, Ankara 06200, Turkey
| | - Murat Gultekin
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey
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Lu Y, Wu H, Fu K, Shen Y, Li L, Liao Z, Liu Y, Kang Y, Zhang Y. PAX1 methylation as a robust predictor: developing and validating a nomogram for assessing endocervical curettage (ECC) necessity in human papillomavirus16/18-positive women undergoing colposcopy. Clin Epigenetics 2024; 16:77. [PMID: 38849868 PMCID: PMC11157736 DOI: 10.1186/s13148-024-01691-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/03/2024] [Indexed: 06/09/2024] Open
Abstract
OBJECTIVE The major challenge in routine endocervical curettage (ECC) among Human Papillomavirus (HPV) 16/18-positive patients is that only a small fraction benefit. Nevertheless, current reported models often overestimate the validity and necessity of ECC, making it difficult to improve benefits for patients. This research hypothesized that assessing paired boxed gene 1 methylation levels (PAX1m) and clinical characteristics could enhance the predictive accuracy of detecting additional high-grade squamous intraepithelial lesions or worse (HSIL +) through ECC that were not identified by colposcopy-directed biopsy (CDB). METHODS Data from 134 women with HPV16/18 positivity undergoing CDB and ECC between April 2018 and April 2022 were collected and analyzed. Quantitative methylation-specific polymerase chain reaction (qMSP) was utilized to measure PAX1m, expressed as ΔCp. Univariate and multivariate regression analyses were conducted to screen variables and select predictive factors. A nomogram was constructed using multivariate logistic regression to predict additional HSIL + detected by ECC. The discrimination, calibration, and clinical utility of the nomogram were evaluated using receiver operating characteristic curves (ROC) and the calibration plot. RESULTS Age (odds ratio [OR], 5.654; 95% confidence interval [CI], 1.131-37.700), cytology (OR, 24.978; 95% CI, 3.085-540.236), and PAX1 methylation levels by grade (PAX1m grade) (OR, 7.801; 95% CI, 1.548-44.828) were independent predictive factors for additional detection of HSIL + by ECC. In HPV16/18-positive women, the likelihood of additional detection of HSIL + through ECC increased with the severity of cytological abnormalities, peaking at 43.8% for high-grade cytological lesions. Moreover, when cytological findings indicated low-grade lesions, PAX1 methylation levels were positively correlated with the additional detection of HSIL + by ECC (P value < 0.001). A nomogram prediction model was developed (area under curve (AUC) = 0.946; 95% CI, 0.901-0.991), demonstrating high sensitivity (90.9%) and specificity (90.5%) at the optimal cutoff point of 107. Calibration analysis confirmed the model's strong agreement between predicted and observed probabilities. CONCLUSION The clinical nomogram presented promising predictive performance for the additional detection of HSIL + through ECC among women with HPV16/18 infection. PAX1 methylation level could serve as a valuable tool in guiding individualized clinical decisions regarding ECC for patients with HPV 16/18 infection, particularly in cases of low-grade cytological findings.
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Affiliation(s)
- Yingnan Lu
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Haiyue Wu
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Kun Fu
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - YuFei Shen
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Lucia Li
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Zexi Liao
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yingzhen Liu
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Yanan Kang
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
| | - Yu Zhang
- Department of Gynecology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
- Gynecological Oncology Research and Engineering Center of Hunan Province, 87 Xiangya Road, Changsha, 410008, Hunan, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.
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McGee AE, Alibegashvili T, Elfgren K, Frey B, Grigore M, Heinonen A, Jach R, Jariene K, Kesic V, Küppers V, Kyrgiou M, Leeson S, Louwers J, Mazurec M, Mergui J, Pedro A, Šavrova A, Siegler E, Tabuica U, Trojnarska D, Trzeszcz M, Turyna R, Volodko N, Cruickshank ME. European consensus statement on expert colposcopy. Eur J Obstet Gynecol Reprod Biol 2023; 290:27-37. [PMID: 37716200 DOI: 10.1016/j.ejogrb.2023.08.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Following the publication of the European consensus statement on standards for essential colposcopy in 2020, the need for standards relating to more complex and challenging colposcopy practice was recognised. These standards relate to colposcopy undertaken in patients identified through cervical screening and tertiary referrals from colposcopists who undertake standard colposcopy only. This set of recommendations provides a review of the current literature and agreement on care for recognised complex cases. With good uptake of human papillomavirus (HPV) immunisation, we anticipate a marked reduction in cervical disease over the next decade. Still, the expert colposcopist will continue to be vital in managing complex cases, including previous cervical intraepithelial neoplasia (CIN)/complex screening histories and multi-zonal disease. AIMS To provide expert guidance on complex colposcopy cases through published evidence and expert consensus. MATERIAL & METHODS Members of the EFC and ESGO formed a working group to identify topics considered to be the remit of the expert rather than the standard colposcopy service. These were presented at the EFC satellite meeting, Helsinki 2021, for broader discussion and finalisation of the topics. RESULTS & DISCUSSION The agreed standards included colposcopy in pregnancy and post-menopause, investigation and management of glandular abnormalities, persistent high-risk HPV+ with normal/low-grade cytology, colposcopy management of type 3 transformation zones (TZ), high-grade cytology and normal colposcopy, colposcopy adjuncts, follow-up after treatment with CIN next to TZ margins and follow-up after treatment with CIN with persistent HPV+, and more. These standards are under review to create a final paper of consensus standards for dissemination to all EFC and ESGO members.
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Affiliation(s)
- A E McGee
- Aberdeen Centre for Women's Health Research (ACWHR), University of Aberdeen, UK.
| | - T Alibegashvili
- Department of Gynaecology, Georgian National Screening Center, Tbilisi, Georgia
| | - K Elfgren
- Karolinska Institutet, Stockholm, Sweden
| | - B Frey
- Frauenklinik Baselland, Switzerland
| | - M Grigore
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy "Grigore T. Popa" Iasi, Romania
| | - A Heinonen
- Department of Obstetrics and Gynecology, University of Helsinki, and Helsinki University Hospital
| | - R Jach
- Institute of Nursing and Obstetrics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - K Jariene
- Department of Obstetrics and Gynecology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - V Kesic
- Faculty of Medicine, University of Belgrade, Clinic of Obstetrics and Gynaecology, Clinical Center of Serbia, Belgrade, Serbia
| | - V Küppers
- Frauenheilkunde & Geburtshilfe, Zytologisches Labor, Dysplasie-Sprechstunde, Düsseldorf, Germany
| | - M Kyrgiou
- IRDB, MDR & Surgery and Cancer, Faculty of Medicine, Imperial College London, UK
| | - S Leeson
- West London Gynaecological Cancer Centre, Imperial College NHS Trust, UK; Department of Obstetrics and Gynaecology, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Wales, UK
| | - J Louwers
- Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, the Netherlands
| | - M Mazurec
- Corfamed Woman's Health Center, Kluczborska, Wroclaw, Poland; Department of Pathology and Clinical Cytology, University Hospital in Wroclaw, Poland
| | - J Mergui
- Department of Gynecological and Breast Surgery and Oncology, Pitié-Salpêtrière, Assistance Publique des Hôpitaux de Paris (AP-HP), University Hospital, Paris, France
| | - A Pedro
- Department of Obstetrics and Gynaecology, CUF Sintra Hospital, Sintra, Portugal
| | - A Šavrova
- Gynaecology Centre, North Estonia Medical Centre, Estonia
| | - E Siegler
- The Israeli Society of Colposcopy and Cervical and Vulvar Pathology, Peretz Berenstein St, Haifa, Israel
| | - U Tabuica
- Department of Obstetrics and Gynaecology, State University of Medicine and Pharmacy, Referral Center of Colposcopy, Chisinau, Moldavia
| | - D Trojnarska
- Institute of Nursing and Obstetrics, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - M Trzeszcz
- Corfamed Woman's Health Center, Kluczborska, Wroclaw, Poland; Department of Pathology and Clinical Cytology, University Hospital in Wroclaw, Poland
| | - R Turyna
- Institute for the Care of Mother and Child, Prague 4, Czech Republic; Third Faculty of Medicine, Charles University, Prague 10, Czech Republic; Institute of Postgraduate Education in Health Care - IPVZ, Prague 10, Czech Republic
| | - N Volodko
- Department of Oncology and Radiology, Danylo Halytsky Lviv national medical university, Lviv, Ukraine
| | - M E Cruickshank
- Aberdeen Centre for Women's Health Research (ACWHR), University of Aberdeen, UK
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Panagakis G, Papapanagiotou IK, Theofanakis C, Tsetsa P, Kontogeorgi A, Thomakos N, Rodolakis A, Haidopoulos D. Detection of High-Grade Cervical Intraepithelial Neoplasia by Electrical Impedance Spectroscopy in Women Diagnosed with Low-Grade Cervical Intraepithelial Neoplasia in Cytology. Life (Basel) 2023; 13:2139. [PMID: 38004279 PMCID: PMC10672316 DOI: 10.3390/life13112139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/19/2023] [Accepted: 10/29/2023] [Indexed: 11/26/2023] Open
Abstract
The authors attempt to address the importance of timely detection and management of cervical intraepithelial neoplasia (CIN) to prevent cervical cancer. The study focused on the potential of electrical impedance spectroscopy (EIS) as an adjunct to colposcopy, aiming to enhance the accuracy of identifying high-grade cervical lesions. Colposcopy, a widely used technique, exhibited variable sensitivity in detecting high-grade lesions, which relies on the expertise of the operator. The study's primary objective is to evaluate the effectiveness of combining colposcopy with EIS in detecting high-grade cervical lesions among patients initially diagnosed with low-grade CIN based on cytology. We employed a cross-sectional observational design, recruiting 101 women with abnormal cervical cytology results. The participants underwent colposcopy with acetic acid and subsequent EIS using the ZedScan device. The ZedScan results are categorized into color-coded probability levels, with red indicating the highest likelihood of high-grade squamous intraepithelial lesions (HSIL) occurrence. Results revealed that ZedScan exhibits a sensitivity rate of 89.5% and a specificity rate of 84% for detecting high-grade lesions. Colposcopy, on the other hand, recorded a sensitivity rate of 85.5% and a specificity rate of 92%. The agreement rate between ZedScan and biopsy is 79.2%, as indicated by a kappa coefficient of 0.71, while the agreement rate between colposcopy and biopsy is 74.3%, with a kappa coefficient of 0.71.
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Affiliation(s)
- Georgios Panagakis
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Ioannis K. Papapanagiotou
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Charalampos Theofanakis
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Paraskevi Tsetsa
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Adamantia Kontogeorgi
- Department of Obstetrics and Gynecology, Attikon General Hospital, University of Athens, Rimini 1, 124 62 Haidari, Greece
| | - Nikolaos Thomakos
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Alexandros Rodolakis
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
| | - Dimitrios Haidopoulos
- Department of Obstetrics and Gynecology, Alexandra General Hospital, University of Athens, 4-2 Lourou, 115 28 Athens, Greece; (G.P.); (I.K.P.); (C.T.); (P.T.); (N.T.); (A.R.); (D.H.)
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Feng C, Gu L, Wei Y, Niu J, Yang H, Hong Z, Qiu L. Analysis of outcomes following loop electrosurgical excision and clinical features of patients with cervical high-grade squamous intraepithelial lesions with abnormal preoperative endocervical curettage. World J Surg Oncol 2023; 21:237. [PMID: 37537635 PMCID: PMC10399018 DOI: 10.1186/s12957-023-03088-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/28/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE The purpose of this study was to identify the clinical characteristics of patients with high-grade squamous intraepithelial lesions (HSIL) with abnormal endocervical curettage (ECC) and to evaluate the efficacy of abnormal preoperative ECC in predicting recurrence after a loop electrosurgical excision procedure (LEEP). METHODS We retrospectively analyzed a total of 210 cases of histological HSIL in female patients diagnosed using cervical biopsy and/or indiscriminating ECC, and these included 137 cases with normal ECC and 63 cases with abnormal ECC. We also collected preoperative information and data on postoperative human papillomavirus (HPV) and histological outcomes within 2 years. RESULTS The additional detection rate of HSIL using indiscriminating ECC was 5%. Patients with abnormal ECC were older (P < 0.001), predominantly menopausal (P = 0.001), had high-grade cytology (P = 0.032), a type 3 transformation zone (P = 0.046), and a higher proportion of HPV type 16/18 infection (P = 0.023). Moreover, age (odds ratio [OR] = 1.078, 95% confidence interval [CI] = 1.0325-1.1333, P = 0.003) and HPV 16/18 infection (OR = 2.082, 95% CI = 1.042-4.2163, P = 0.038) were independent risk factors for abnormal ECC. With an observed residual lesion/recurrence rate of 9.5% over the 24-month follow-up, we noted a 9.3% higher rate in the abnormal ECC group when compared with the normal ECC group. Abnormal preoperative ECC (OR = 4.06, 95% CI = 1.09-15.14, P = 0.037) and positive HPV at the 12-month follow-up (OR = 16.55, 95% CI = 3.54-77.37, P = 0.000) were independent risk factors for residual disease/recurrence. CONCLUSION Preoperative ECC was one of the risk factors for post-LEEP residual/recurrent HSIL, and detecting abnormal ECC when managing older patients or patients with HPV 16/18 infection during colposcopy is critical.
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Affiliation(s)
- Chunyang Feng
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China
| | - Liying Gu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China
| | - Yingting Wei
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China
| | - Jiaxin Niu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China
| | - Haima Yang
- School of Optical-Electrical and Computer Engineering, University of Shanghai for Science and Technology, Shanghai, 200093, China
| | - Zubei Hong
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China.
| | - Lihua Qiu
- Department of Obstetrics and Gynecology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China.
- Shanghai Key Laboratory of Gynecologic Oncology, Shanghai, 200127, China.
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Shanghai, 200127, China.
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Chu MMY, Cheung CSY, Ngu SF, Tse KY, Ip PPC, Cheung ANY, Ngan HYS, Chan KKL. The Value of Four-Quadrant Cervical Biopsy in Women with Different Colposcopic Impressions. Diagnostics (Basel) 2023; 13:2384. [PMID: 37510128 PMCID: PMC10378482 DOI: 10.3390/diagnostics13142384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
The aim of this study was to compare the diagnostic efficacy of colposcopic-directed biopsy and four-quadrant biopsy in detecting high-grade cervical intra-epithelial neoplasia (CIN). Women attending three women's clinics for routine cervical screening were recruited. Colposcopy was arranged for women with any cytologic abnormalities greater than atypical squamous cells of undetermined significance (ASCUS), two consecutive ASCUS results or positive HPV testing. During colposcopy, a cervical biopsy was taken from the most suspicious area, but more than one biopsy was allowed. Four-quadrant biopsies at 3, 6, 9 and 12 o'clock and an endocervical curettage were also taken in all cases. A total of 1522 colposcopies were performed in 1311 subjects from June 2010 to August 2017, with 118 cases of high-grade CIN diagnosed. Colposcopic-directed biopsy detected 50.8% of the 118 high-grade CIN, while four-quadrant biopsy detected 86.4% (p < 0.0001). Twenty-seven cases (22.9%) of high-grade CIN were diagnosed in women with normal or unsatisfactory colposcopy. Among the 64 cases with low-grade colposcopic impression, four-quadrant biopsy detected significantly more high-grade CIN (53 cases, 82.8%) than colposcopic-directed biopsy (35 cases, 56.3%) (p = 0.0011). Four-quadrant cervical biopsies should be considered for all women with an abnormal smear or positive HPV testing, especially in patients with low-grade/normal/unsatisfactory colposcopy.
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Affiliation(s)
- Mandy Man-Yee Chu
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Charleen Sze-Yan Cheung
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Siew-Fei Ngu
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Ka-Yu Tse
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Philip Pun-Ching Ip
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Annie Nga-Yin Cheung
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Hextan Yuen-Sheung Ngan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - Karen Kar-Loen Chan
- Department of Obstetrics and Gynecology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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Colposcopy Standards: Guidelines for Endocervical Curettage at Colposcopy. J Low Genit Tract Dis 2023; 27:97-101. [PMID: 36222824 PMCID: PMC9770112 DOI: 10.1097/lgt.0000000000000710] [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] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The most recent guidelines for colposcopy practice in the United States, the 2017 Colposcopy Standards Consensus Guidelines, did not include recommendations for endocervical curettage (ECC). This document provides updated guidelines for use of ECC among patients referred for colposcopy. METHODS Consensus guidelines for the use of ECC were developed in 2012. To update these guidelines in concordance with the 2017 Colposcopy Standards process, an expert workgroup was convened in 2021. Literature had been previously reviewed through 2011, before the 2012 guideline. Literature from the years 2012-2021 and data from the NCI Biopsy study were reviewed, focusing on the additional yield of ECC. RESULTS Endocervical curettage is recommended for patients with high-grade cytology, human papillomavirus 16/18 infection, positive results on dual staining for p16/Ki67, for those previously treated for known or suspected cervical precancer or considering observation of cervical intraepithelial neoplasia grade 2, and when the squamocolumnar junction is not fully visualized at colposcopy. Endocervical curettage is preferred for all patients aged older than 40 years. Endocervical curettage is acceptable for all nonpregnant patients undergoing colposcopy but may be omitted when a subsequent excisional procedure is planned, the endocervical canal does not admit a sampling device, or in nulliparous patients aged younger than 30 years, with cytology reported as atypical squamous cells of undetermined significance or low-grade squamous intraepithelial lesion regardless of whether the squamocolumnar junction is fully visualized. Endocervical curettage is unacceptable in pregnancy. CONCLUSIONS These guidelines for ECC add to the 2017 consensus recommendations for colposcopy practice in the United States.
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Macios A, Nowakowski A. False Negative Results in Cervical Cancer Screening-Risks, Reasons and Implications for Clinical Practice and Public Health. Diagnostics (Basel) 2022; 12:1508. [PMID: 35741319 PMCID: PMC9222017 DOI: 10.3390/diagnostics12061508] [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: 05/04/2022] [Revised: 06/06/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
False negative (FN) results in cervical cancer (CC) screening pose serious risks to women. We present a comprehensive literature review on the risks and reasons of obtaining the FN results of primary CC screening tests and triage methods and discuss their clinical and public health impact and implications. Misinterpretation or true lack of abnormalities on a slide are the reasons of FN results in cytology and p16/Ki-67 dual-staining. For high-risk human papillomavirus (HPV) molecular tests, those include: truly non-HPV-associated tumors, lesions driven by low-risk HPV types, and clearance of HPV genetic material before sampling. Imprecise disease threshold definition lead to FN results in visual inspection with acetic acid. Lesions with a discrete colposcopic appearance are a source of FN in colposcopic procedures. For FAM19A4 and hsa-miR124-2 genes methylation, those may originate from borderline methylation levels. Histological misinterpretation, sampling, and laboratory errors also play a role in all types of CC screening, as well as reproducibility issue, especially in methods based on human-eye evaluation. Primary HPV-based screening combined with high quality-assured immunocytochemical and molecular triage methods seem to be an optimal approach. Colposcopy with histological evaluation remains the gold standard for diagnosis but requires quality protocols and assurance measures.
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Affiliation(s)
- Anna Macios
- Doctoral School of Translational Medicine, Centre of Postgraduate Medical Education, Marymoncka Street 99/103, 01-813 Warsaw, Poland
- Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, 02-781 Warsaw, Poland
| | - Andrzej Nowakowski
- Department of Cancer Prevention, The Maria Sklodowska-Curie National Research Institute of Oncology, Roentgen Street 5, 02-781 Warsaw, Poland
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Li Y, Luo H, Zhang X, Chang J, Zhao Y, Li J, Li D, Wang W. Development and validation of a clinical prediction model for endocervical curettage decision-making in cervical lesions. BMC Cancer 2021; 21:804. [PMID: 34253177 PMCID: PMC8276473 DOI: 10.1186/s12885-021-08523-y] [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: 04/15/2021] [Accepted: 06/17/2021] [Indexed: 12/01/2022] Open
Abstract
Background In the absence of practical and reliable predictors for whether the endocervical curettage (ECC) procedure should be performed, decisions regarding patient selection are usually based on the colposcopists’ clinical judgment instead of evidence. We aimed to develop and validate a practical prediction model that uses available information to reliably estimate the need to perform ECC in patients suspected of having cervical lesions. Methods In this retrospective study, 2088 patients who underwent colposcopy, colposcopically directed biopsy (CDB) and ECC procedures between September 2019 and September 2020 at the Second Hospital of Shanxi Medical University were included. The data were analyzed with univariate and multivariable logistic regression. Least absolute shrinkage and selection operator (LASSO) was used to select predictors for ECC positivity. The ECC prediction model was presented as a nomogram and evaluated in terms of discrimination and calibration. Furthermore, this model was validated internally with cross-validation and bootstrapping. Results Significant trends were found for ECC positivity with increasing age (P = 0.001), menopause (P = 0.003), Human papillomavirus (HPV) status (P < 0.001), severity of ThinPrep Cytological Test (TCT) (P < 0.001), original squamous epithelium ectopia (P = 0.037) and colposcopy impression (P < 0.001) by multivariable logistic regression analysis. The ECC prediction model was developed based on the following predictors: age, menopause, symptom of contact bleeding, severity of TCT, HPV status, cervix visibility, original squamous epithelium ectopia, acetowhite changes and colposcopic impression. This model had satisfactory calibration and good discrimination, with an area under the receiver operator characteristic curve (AUC) of 0.869 (95% confidence interval 0.849 to 0.889). Conclusions A readily applicable clinical prediction model was constructed to reliably estimate the probability of ECC positivity in patients suspicious of having cervical lesions, which may help clinicians make decisions regarding the ECC procedure and possibly prevent adverse effects. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08523-y.
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Affiliation(s)
- Yuanxing Li
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.,Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Haixia Luo
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.,Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Xiu Zhang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.,Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Jingjing Chang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.,Shanxi Medical University, Taiyuan, 030000, Shanxi, China
| | - Yueyang Zhao
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Jing Li
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Dongyan Li
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - Wei Wang
- Department of Obstetrics and Gynecology, the Second Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China.
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Bruehl FK, Dyhdalo KS, Hou Y, Clapacs E, Przybycin CG, Reynolds JP. Cytology and curetting diagnosis of endocervical adenocarcinoma. J Am Soc Cytopathol 2020; 9:556-562. [PMID: 32624383 DOI: 10.1016/j.jasc.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Papanicolaou testing is effective in identifying squamous intraepithelial lesions of the cervix. Endocervical adenocarcinoma (EAC) and adenocarcinoma in situ (AIS) are far less commonly identified. Endocervical curettings (ECCs) are usually obtained after colposcopic biopsy, sample the endocervical canal, and aid in the detection of endocervical glandular lesions. Here, we examine the utility of Papanicolaou testing and endocervical curetting for detecting AIS and EAC. MATERIALS AND METHODS Cases from 2007 to 2019 with a histologically confirmed diagnosis of AIS and EAC were identified and the clinical data and diagnostic material, including the cytology and surgical specimens, obtained. RESULTS A total of 108 cases of AIS and EAC were identified, Papanicolaou tests were performed in 97 of these cases, and ECC in 87. AIS or EAC were detected in 46.4% of Papanicolaou tests; 41.4% of ECC showed AIS or EAC. A total of 92.7% of cases were positive for high-risk human papillomavirus (HPV) and concurrent squamous intraepithelial lesion was present in 53.3% of cases. AIS or EAC were more commonly identified in cases without concurrent squamous intraepithelial lesions. CONCLUSIONS Papanicolaou testing and endocervical curettings have a low detection rate for AIS and EAC. The majority of AIS and EAC cases test positive for high-risk HPV. Papanicolaou test and ECC show different detection rates and are complementary tools in patients with AIS and EAC. In some settings, an ECC can increase the diagnostic sensitivity and specificity of the pathologic diagnosis.
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Affiliation(s)
- Frido K Bruehl
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kathryn S Dyhdalo
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Yanjun Hou
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Elisha Clapacs
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christopher G Przybycin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
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11
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Al-Nourhji O, Dermawan JK, Booth CN, Underwood D, Abdul-Karim FW. Role of ThinPrep liquid-based cytology in evaluation of the endocervical canal in patients with abnormal cervical screening. J Am Soc Cytopathol 2019; 8:278-283. [PMID: 31186178 DOI: 10.1016/j.jasc.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/02/2019] [Accepted: 05/13/2019] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Endocervical sampling is frequently used as an adjunct to colposcopy. Few studies address the role of endocervical brushing (ECB) with liquid-based cytology (LBC) for evaluation of the endocervical canal. We assessed the roles of ThinPrep (TP) LBC of ECB specimens and cell blocks (CBs). MATERIALS AND METHODS Pathology archives were searched for ECB specimens from 2010-2015. Preceding Papanicolaou test interpretation, human papillomavirus status, concurrent and follow-up surgical specimens, and ECB diagnoses were recorded. CB cellularity, when available, was scored on a scale of 0 to 4. The cellularity of the TP and CBs was compared. RESULTS Of 365 ECB cases, 6 (1.6%) were insufficient for diagnosis, compared with a 5% rate for endocervical curettings. Eleven ECB cases (3%) showed low cellularity. Of the 241 (66%) cases with concurrent biopsies, the ECB diagnosis agreed with the biopsy diagnosis (within 1 grade) in 198 (82%) cases. In 9 (2.5%) cases, ECB was the only means of diagnosis of a high-grade squamous intraepithelial lesion / adenocarcinoma in situ confirmed on follow-up. Compared with TP LBC, the CBs (performed in 84 [23%] of cases) were of greater cellularity in 30 (42%) and of equal cellularity in 17 (24%). None of the CBs showed an additional epithelial abnormality missed in TP LBC. CONCLUSIONS TP LBC is capable of detecting endocervical epithelial abnormalities and may be used as a substitute for endocervical curettings. Performing a CB did not lead to detection of additional abnormalities, although it complemented TP findings and facilitates the performance of ancillary studies.
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Affiliation(s)
- Omar Al-Nourhji
- Department of Pathology & Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Josephine Kamtai Dermawan
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christine N Booth
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Dawn Underwood
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fadi W Abdul-Karim
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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12
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Rodríguez-Trujillo A, Martí C, Angeles MA, Sierra A, Esteve R, Saco A, Barnadas E, Marimón L, Nicolás I, Torné A, Ordi J, del Pino M. Value of HPV 16/18 Genotyping and p16/Ki-67 Dual Staining to Predict Progression to HSIL/CIN2+ in Negative Cytologies From a Colposcopy Referral Population. Am J Clin Pathol 2018; 150:432-440. [PMID: 30052715 DOI: 10.1093/ajcp/aqy071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To assess the prognostic value of human papillomavirus (HPV) 16/18 genotyping and p16/Ki-67 dual staining cytology in high-risk HPV (hrHPV)-positive women with no lesion or minor abnormalities. METHODS We evaluated progression to high-grade squamous intraepithelial lesion/cervical intraepithelial neoplasia grades 2 to 3 or cervical cancer (HSIL/CIN2+), persistence/regression of hrHPV infection in women referred to colposcopy showing hrHPV infection, histology diagnosis different from HSIL/CIN2+, and negative cytology. HPV 16/18 genotyping and dual staining were performed in liquid-based cytologic specimens obtained on the first visit. RESULTS Progression was observed in 16 (8.0%) of 200 women. Those with HPV 16/18 infection had an increased risk of progression compared with women infected by other hrHPV types, and they also showed more persistence. However, no association was observed between progression or persistence and the result of the dual staining. CONCLUSIONS HPV 16/18-positive women with no lesions or minor abnormalities are at high risk of progression to HSIL/CIN2+ and hrHPV persistence.
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Affiliation(s)
- Adriano Rodríguez-Trujillo
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Cristina Martí
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Martina Aida Angeles
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Adriana Sierra
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Roser Esteve
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Adela Saco
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Esther Barnadas
- Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Lorena Marimón
- Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Inmaculada Nicolás
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Aureli Torné
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jaume Ordi
- Department of Pathology, Hospital Clínic, University of Barcelona, Barcelona, Spain
- Institut de Salut Global de Barcelona (ISGlobal), Barcelona, Spain
| | - Marta del Pino
- Institute Clinic of Gynaecology, Obstetrics, and Neonatology, Hospital Clínic–Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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13
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Song Y, Zhao YQ, Li L, Pan QJ, Li N, Zhao FH, Chen W, Zhang X, Qiao YL. A retrospective analysis of the utility of endocervical curettage in screening population. Oncotarget 2018; 8:50141-50147. [PMID: 28404931 PMCID: PMC5564837 DOI: 10.18632/oncotarget.15658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/24/2017] [Indexed: 11/25/2022] Open
Abstract
The performance of endocervical curettage (ECC) is a dispute in population screening programs. Data of 3,460 women referred to colposcopy examination and had completed pathological results in the Shanxi Province Cervical Cancer Screening Study I and II were reviewed. Among them, 0.6% and 2.7% women were identified as the histopathological confirmed high-grade squamous intraepithelial lesion or worse (HSIL+) by ECC alone or both ECC and quadrants biopsy respectively. Age, cytology, and colposcopy impression are the impact factors for the HSIL+ yield of ECC (P<0.05). The age-adjusted odds ratio for cytology and colposcopic impression were 5.283 (95%CI: 3.989-6.997) and 3.609 (95%CI: 2.910-4.476) respectively. In low-grade squamous intraepithelial lesion cytology and abnormal colposcopy, no additional HSIL+ was found by ECC. In low-grade squamous intraepithelial lesion cytology but normal colposcopy, the additional yield was 0.6%, 0.8% and 1.1% for the three age groups respectively. In high-grade squamous intraepithelial lesion or worse cytology, the additional HSIL+ yield by ECC ranged between 1.4% and 6.6%. We conclude that the performance of ECC increases with age, the severity of cytology, and colposcopic impression. For women 35 years and older, ECC should be performed if the cytological finding is high-grade or worse in cervical cancer screening program.
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Affiliation(s)
- Yan Song
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yu-Qian Zhao
- Department of Cancer Prevention and Treatment, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.,Department of Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ling Li
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Qin-Jin Pan
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Nan Li
- Department of Gynaecology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang-Hui Zhao
- Department of Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wen Chen
- Department of Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xun Zhang
- Department of Pathology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - You-Lin Qiao
- Department of Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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14
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Crothers BA. Cytologic-histologic correlation: Where are we now, and where are we going? Cancer Cytopathol 2018; 126:301-308. [DOI: 10.1002/cncy.21991] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 03/06/2018] [Accepted: 03/06/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Barbara A. Crothers
- Joint Pathology Center; Uniformed Services University of the Health Sciences; Silver Spring Maryland
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15
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Diagnosis of Cervical Precancers by Endocervical Curettage at Colposcopy of Women With Abnormal Cervical Cytology. Obstet Gynecol 2017; 130:1218-1225. [PMID: 29112672 DOI: 10.1097/aog.0000000000002330] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the performance of routine endocervical curettage (ECC) for diagnosing high-grade cervical intraepithelial neoplasia (CIN) 2 or worse and additional precancers not otherwise detected by ectocervical biopsies. METHODS In a secondary analysis of the Biopsy Study, a cross-sectional study conducted between 2009 and 2012 at the University of Oklahoma Health and Sciences Center that found an incremental increase in detection of cervical precancers by multiple biopsies at colposcopy, ECC was performed in most women aged 30 years or older. Cervical intraepithelial neoplasia 2 or worse yield by ECC alone was evaluated in analyses stratified by cervical cytology (atypical squamous cells of undetermined significance [ASC-US] or low-grade squamous intraepithelial lesions [LSIL] compared with atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesions [ASC-H] or high-grade squamous intraepithelial lesions [HSIL] or worse), colposcopic impression (less than high-grade compared with high-grade), human papillomavirus (HPV)-16 infection status, whether the examination was satisfactory, and by ECC indications per the current guidelines for cervical cancer screening. The diagnostic value of ECC for detecting additional disease was evaluated by the number of lesion-directed ectocervical biopsies. RESULTS Of the 204 women aged 30 years or older, 181 (88.7%) underwent ECC. Overall ECC detected 14.4% CIN 2 or worse (95% CI 10.0-20.2%). Endocervical curettage was more likely to find disease in the endocervix among women with high-grade cytology, positive HPV-16 infection, or high-grade colposcopic impressions (respective P values <.05). Among women with ASC-US or LSIL cytology, those with an unsatisfactory examination had a 13.0% CIN 2 or worse yield on ECC (95% CI 6.1-25.7); when colposcopic examination was normal or satisfactory with visible abnormal lesions, ECC detected less than 5% CIN 2 or worse in the endocervix. An ASC-H or HSIL or worse cytology was associated with a CIN 2 or worse yield of 25.8% by ECC (95% CI 16.6-37.9%). However, ECC found only 3.9% (95% CI 1.9-7.8%) additional CIN 2 or worse beyond the cumulative disease detected by up to four biopsies of visible acetowhite ectocervical lesions. Additional CIN 2 or worse yield by ECC increased when fewer lesion-directed biopsies were taken (P<.05). CONCLUSION The additional yield of CIN 2 or worse by ECC in a colposcopy with up to four ectocervical biopsies was low. Based on our findings, we recommend routine ECC be performed in women aged 45 years old or older with HPV-16 infection and in any woman aged 30 years or older with HSIL or worse or ASC-H cytology, high-grade colposcopic impression, or ASC-US or LSIL cytology and an unsatisfactory examination. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00339989.
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16
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Muszynski C, Dupont E, Vaysse B, Lanta S, Tidy J, Sergent F, Gondry J. The impact of using electrical impedance spectroscopy (ZedScan) on the performance of colposcopy in diagnosing high grade squamous lesions of the cervix. J Gynecol Obstet Hum Reprod 2017; 46:669-673. [PMID: 28866125 DOI: 10.1016/j.jogoh.2017.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the efficacy of colposcopy plus ZedScan, which measures changes in tissue electrical impedance, for detecting intraepithelial high-grade lesions compared to colposcopy alone. METHODS A prospective study conducted at a university hospital colposcopy clinic. Patients referred following abnormal cervical cytology or colposcopic follow up were examined by colposcopy plus ZedScan to assess the cervix. The results of ZedScan directed and colposcopically directed biopsies were compared. RESULTS Ninety-one patients were included in this study. The median age was 33 years. Eighty (88%) were referred with abnormal cytology; LSIL 45%, ASCUS 27%, ACS-H 8%, HSIL 7%, AGC 1% and 12% follow-up postconisation or colposcopic follow up. Colposcopy alone detected 18 high-grade lesions with 64 women undergoing biopsy with a total of 115 biopsies being taken with a sensitivity of 60% and NPV estimated at 81.7%. ZedScan with colposcopy increased the detection of high-grade lesions by 47.3%, identifying 27 high-grade lesions and one case of invasive cancer. Sensitivity was 93.1% and NPV estimated at 91.3%. A combination of normal colposcopy practice and ZedScan had a sensitivity and NPV of 100%. CONCLUSION ZedScan used in conjunction with the colposcopy improves sensitivity in detecting high-grade lesions at the expense of a moderate increase in the number of biopsies.
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Affiliation(s)
- C Muszynski
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, site sud D 408, 80054 Amiens cedex 1, France.
| | - E Dupont
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, site sud D 408, 80054 Amiens cedex 1, France
| | - B Vaysse
- Direction de l'information médicale, CHU d'Amiens-Picardie, site sud (Amiens) D 408, 80054 Amiens cedex 1, France
| | - S Lanta
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, site sud D 408, 80054 Amiens cedex 1, France
| | - J Tidy
- Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Rd, S10 2JF Sheffield, Royaume-Uni
| | - F Sergent
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, site sud D 408, 80054 Amiens cedex 1, France
| | - J Gondry
- Service de gynécologie-obstétrique, CHU d'Amiens-Picardie, site sud D 408, 80054 Amiens cedex 1, France
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Schmidt D. [Modern biomarkers for precancerous lesions of the uterine cervix : Histological-cytological correlation and use]. DER PATHOLOGE 2017; 37:534-541. [PMID: 27638536 DOI: 10.1007/s00292-016-0231-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The correlation between the cytological findings from the PAP smear and the histological outcome in cases where the cytological findings must be histologically verified, is an integral component of the German screening program for cervical cancer. These data are collected nationwide as part of a benchmarking process by the individual Associations of Statutory Health Insurance Physicians (KV) in the federal states and reported to the National Association of Statutory Health Insurance Physicians (KBV) in Berlin. In most cases there is a good correlation between cytology and histology but in some cases either a different grade of severity of cervical intraepithelial neoplasia (CIN) is found or the histological findings are negative. The reasons for a lack of correlation can be insufficient sampling in the cytology or the biopsy or a misinterpretation of the individual findings. Although the findings from H&E sections are considered to be the gold standard in the histological evaluation, it has long been known that the interobserver agreement in these preparations is only moderate. A significant improvement becomes apparent, firstly by the classification of cervical cancer precursors into low-grade and high-grade groups and secondly by the targeted application of biomarkers, in particular p16 and Ki-67, according to the recommendations of the lower anogenital squamous terminology standardization (LAST) project. The biomarkers p16 and Ki-67 should be used in the differential diagnostics between reactive and reparative alterations and for further differentiation of a CIN grade 2 but not to confirm a CIN grade 3. It is still unclear whether p16 is suitable as a prognostic marker for low-grade lesions.
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Affiliation(s)
- D Schmidt
- Institut für Pathologie, Gereonstr. 14a, 41747, Viersen, Deutschland.
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