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Zhou Q, Chen F, Wang Y, Qu W, Gong Y, Cao Y, Zhang H, Wang Q, Chen L, Cong Q, Lin L, Mo J, Bi T, Ding J, Sui L, Li Y. Application of a diagnosis flow draft based on appearance impression for detection of vulvar disease. Diagnosis (Berl) 2024; 11:151-163. [PMID: 38143236 DOI: 10.1515/dx-2023-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/07/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES The aims of this retrospective study were to evaluate the clinical applicability of the latest International Society for the Study of Vulvovaginal Disease (ISSVD) and International Federation for Cervical Pathology and Colposcopy (IFCPC) terminology for vulvar diseases, and to explore a new evaluation flow to optimize decision-making on diagnosis. METHODS A total of 1,068 patients with 5,340 qualified vulvar images were evaluated by observers using 2011 ISSVD and 2011 IFCPC terminology systems. The sensitivity, specificity, positive predictive value, negative predictive value, Youden Index and Overall Diagnostic Value (ODV) were calculated for each finding in the two systems. Then the disease diagnosis order and a diagnosis flow draft (DFD) were obtained. RESULTS A total of 15 kinds of vulvar diseases were diagnosed. The proportion of patients accompanied with cervical or vaginal intraepithelial neoplasia was highest (83.3 %) in vulvar Paget's disease group (p<0.001). Total area of lesions was larger in vulvar Paget's disease, lichen simplex chronicus and lichen sclerosus group (p<0.001). Among the top five findings of ODV, some findings inferred several (≥6) kinds of diseases, while some findings only exist in a certain disease. When the DFD was used, the agreement between the initial impression and histopathology diagnosis was 68.8 %, higher than those when ISSVD an IFCPC terminology systems used (p=0.028), and it didn't change with the experience of the observer (p=0.178). CONCLUSIONS Based on the findings in ISSVD and IFCPC terminology systems, we explored a DFD for observers with different experience on the detection of vulvar disease.
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Affiliation(s)
- Qi Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Fang Chen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Yan Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Wenjie Qu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Yingxin Gong
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Yuankui Cao
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Hongwei Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Qing Wang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Limei Chen
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Qing Cong
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Lin Lin
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Jiayin Mo
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Tianyi Bi
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Jingxin Ding
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Long Sui
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
| | - Yanyun Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, P.R. China
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Origoni M, Cantatore F, Sopracordevole F, Clemente N, Spinillo A, Gardella B, De Vincenzo R, Ricci C, Landoni F, Di Meo ML, Ciavattini A, Di Giuseppe J, Preti E, Iacobone AD, Carriero C, Dellino M, Capodanno M, Perino A, Miglioli C, Insolia L, Barbero M, Candiani M. Colposcopy Accuracy and Diagnostic Performance: A Quality Control and Quality Assurance Survey in Italian Tertiary-Level Teaching and Academic Institutions-The Italian Society of Colposcopy and Cervico-Vaginal Pathology (SICPCV). Diagnostics (Basel) 2023; 13:diagnostics13111906. [PMID: 37296757 DOI: 10.3390/diagnostics13111906] [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: 05/05/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Quality Control (QC) and Quality Assurance (QA) principles are essential for effective cervical cancer prevention. Being a crucial diagnostic step, colposcopy's sensitivity and specificity improvements are strongly advocated worldwide since inter- and intra-observer differences are the main limiting factors. The objective of the present study was the evaluation of colposcopy accuracy through the results of a QC/QA assessment from a survey in Italian tertiary-level academic and teaching hospitals. A web-based, user-friendly platform based on 100 colposcopic digital images was forwarded to colposcopists with different levels of experience. Seventy-three participants were asked to identify colposcopic patterns, provide personal impressions, and indicate the correct clinical practice. The data were correlated with a panel of experts' evaluation and with the clinical/pathological data of the cases. Overall sensitivity and specificity with the threshold of CIN2+ accounted for 73.7% and 87.7%, respectively, with minor differences between senior and junior candidates. Identification and interpretation of colposcopic patterns showed full agreement with the experts' panel, ranging from 50% to 82%, in some instances with better results from junior colposcopists. Colposcopic impressions correlated with a 20% underestimation of CIN2+ lesions, with no differences linked to level of experience. Our results demonstrate the good diagnostic performance of colposcopy and the need for improving accuracy through QC assessments and adhesion to standard requirements and recommendations.
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Affiliation(s)
- Massimo Origoni
- Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy
| | - Francesco Cantatore
- Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy
| | - Francesco Sopracordevole
- Gynecological Oncology Unit, IRCCS Oncological Referral Center (CRO), National Cancer Institute, 33081 Aviano, Italy
| | - Nicolò Clemente
- Gynecological Oncology Unit, IRCCS Oncological Referral Center (CRO), National Cancer Institute, 33081 Aviano, Italy
| | - Arsenio Spinillo
- Department of Obstetrics & Gynecology, IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Barbara Gardella
- Department of Obstetrics & Gynecology, IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy
| | - Rosa De Vincenzo
- Gynecological Oncology Unit, Department of Woman and Child Health and Public Health, IRCCS Policlinico Universitario A. Gemelli, 00168 Rome, Italy
- Department of Health Sciences and Public Health, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Caterina Ricci
- Department of Health Sciences and Public Health, Catholic University of the Sacred Hearth, 00168 Rome, Italy
| | - Fabio Landoni
- Department of Medicine and Surgery, University of Milano Bicocca, Clinic of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Maria Letizia Di Meo
- Department of Medicine and Surgery, University of Milano Bicocca, Clinic of Obstetrics and Gynecology, IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Marche Polytechnic University, 60123 Ancona, Italy
| | - Jacopo Di Giuseppe
- Gynecologic Section, Department of Odontostomatological and Specialized Clinical Sciences, Marche Polytechnic University, 60123 Ancona, Italy
| | - Eleonora Preti
- Preventive Gynecology Unit, IRCCS European Institute of Oncology (IEO), 20141 Milan, Italy
| | - Anna Daniela Iacobone
- Preventive Gynecology Unit, IRCCS European Institute of Oncology (IEO), 20141 Milan, Italy
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy
| | - Carmine Carriero
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Miriam Dellino
- Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Massimo Capodanno
- Department of Obstetrics and Gynecology, University of Napoli, 80138 Naples, Italy
| | - Antonino Perino
- Department of Obstetrics and Gynecology, University of Palermo, 90146 Palermo, Italy
| | - Cesare Miglioli
- Research Center for Statistics, University of Geneva, 1201 Geneva, Switzerland
| | - Luca Insolia
- Research Center for Statistics, University of Geneva, 1201 Geneva, Switzerland
| | - Maggiorino Barbero
- Department of Obstetrics and Gynecology, Azienda Sanitaria Locale di Asti, 14100 Asti, Italy
| | - Massimo Candiani
- Department of Obstetrics & Gynecology, IRCCS Ospedale San Raffaele, Vita Salute San Raffaele University School of Medicine, 20132 Milan, Italy
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Qin D, Bai A, Xue P, Seery S, Wang J, Mendez MJG, Li Q, Jiang Y, Qiao Y. Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology. BMC Cancer 2023; 23:187. [PMID: 36823557 PMCID: PMC9951444 DOI: 10.1186/s12885-023-10648-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Colposcopy is an important tool in diagnosing cervical cancer, and the International Federation of Cervical Pathology and Colposcopy (IFCPC) issued the latest version of the guidelines in 2011. This study aims to systematically assess the accuracy of colposcopy in predicting low-grade squamous intraepithelial lesions or worse (LSIL+) / high-grade squamous intraepithelial lesions or worse (HSIL+) under the 2011 IFCPC terminology. METHODS We performed a systematic review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for studies about the performance of colposcopy in diagnosing cervical intraepithelial neoplasia under the new IFCPC colposcopy terminology from PubMed, Embase, Web of Science and the Cochrane database. Data were independently extracted by two authors and an overall diagnostic performance index was calculated under two colposcopic thresholds. RESULTS Totally, fifteen articles with 22,764 participants in compliance with the criteria were included in meta-analysis. When colposcopy was used to detect LSIL+, the combined sensitivity and specificity were 0.92 (95% CI 0.88-0.95) and 0.51 (0.43-0.59), respectively. When colposcopy was used to detect HSIL+, the combined sensitivity and specificity were 0.68 (0.58-0.76) and 0.93 (0.88-0.96), respectively. CONCLUSION In accordance with the 2011 IFCPC terminology, the accuracy of colposcopy has improved in terms of both sensitivity and specificity. Colposcopy is now more sensitive with LSIL+ taken as the cut-off value and is more specific to HSIL+. These findings suggest we are avoiding under- or overdiagnosis both of which impact on patients' well-being.
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Affiliation(s)
- Dongxu Qin
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Anying Bai
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Peng Xue
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Samuel Seery
- grid.9835.70000 0000 8190 6402Faculty of Health and Medicine, Division of Health Research, Lancaster University, Lancaster, LA1 4YW UK
| | - Jiaxu Wang
- grid.506261.60000 0001 0706 7839School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730 China
| | - Maria Jose Gonzalez Mendez
- grid.411971.b0000 0000 9558 1426School of Public Health, Dalian Medical University, Dalian, 116044 Liaoning China
| | - Qing Li
- grid.469593.40000 0004 1777 204XDiagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity and Child Healthcare Hospital, Shenzhen, 518028 China
| | - Yu Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Youlin Qiao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Campos PL, Guimarães ICCDV, Fialho SCAV, Martins CAO, Rodrigues FR, Velarde LGC, Monteiro DDSA. Association of Swede Score and 2011 IFCPC Nomenclature in Women with Abnormal Cytology. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:938-944. [PMID: 36446560 PMCID: PMC9708394 DOI: 10.1055/s-0042-1751074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE To assess the association between two colposcopic indices, the Swede score and the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) Nomenclature as well as to determine the efficacy of the Swede score with cutoffs of 7 and 8. METHODS In the present cross-sectional pilot study, 34 women who had at least 1 colposcopy-directed biopsy due to abnormal cytology were enrolled. The colposcopic findings were scored by both the Swede score and the 2011 IFCPC Nomenclature and were compared with each other. The Kappa coefficient and the McNemar test were used. Accuracy, sensitivity, specificity, and positive and negative predictive values (NPV and PPV, respectively) were calculated, as well as the effectiveness with cutoffs of 7 and 8 in identifying cervical intraepithelial neoplasm (CIN) 2+ when using the Swede score. RESULTS The correlation between the 2 colposcopic indices was 79.41%. The Kappa coefficient and the McNemar p-value were 0.55 and 0.37, respectively. The IFCPC Nomenclature had sensitivity, specificity, accuracy, PPV, and NPV of 85.71, 55.00, 67.64, 57.14, and 84.61%, respectively. The Swede score had sensitivity, specificity, accuracy, PPV, and NPV of 100, 63.15, 79.41, 68.18, and 100%, respectively. A Swede score cutoff of 7 for CIN 2+ detection had a specificity of 94.73%, while with a cutoff of 8 it increased to 100%. The sensitivity for both values was 60%. The PPV and NPV for cutoffs of 7 and 8 were 90 and 75 and 100 and 76%, respectively. CONCLUSION Although both colposcopic indices have good reproducibility, the Swede score showed greater accuracy, sensitivity, and specificity in identifying CIN 2 + , especially when using a cutoff of 8.
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Affiliation(s)
- Priscila Loyola Campos
- Universidade Federal Fluminense, Maternal – Infant Department Niterói, RJ, Brasil,Address for correspondence Priscila Loyola Campos, MSc Rua Marques do Paraná303, Niterói 24033-900, Rio de JaneiroBrasil
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Zhou Q, Gong Y, Qiu X, Sui L, Zhang H, Wang Y, Lin L, Diao W, Li Y. Visual appearance of the uterine cervix differs on the basis of HPV type status in high-grade squamous intraepithelial lesion: the results of a reliable method. BMC Womens Health 2022; 22:24. [PMID: 35094702 PMCID: PMC8801095 DOI: 10.1186/s12905-021-01565-1] [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: 07/16/2021] [Accepted: 12/08/2021] [Indexed: 12/24/2022] Open
Abstract
Background This study aimed to evaluate the differences in cervical appearance among different human papillomavirus (HPV) genotypes in patients with high-grade squamous intraepithelial lesions (HSILs). Methods
A total of 239 histopathological HSIL patients were included and divided into eight groups on the basis of HPV genotype in this prospective study. We present a reliable imaging method that provides reproducible, sensitive and unbiased assessments of cervical appearance characteristics. Colorimetric and morphometric data of colposcopic patterns after the application of acetic acid and iodine were acquired using ImageJ software and the surrounding normal regions were used as controls. Results The differences in red, green, blue and mean greyscale values in acetowhite epithelium obtained from ImageJ were not significant between the HPV16 and HPV18 groups (P < 0.05). The differences in red, green, and mean greyscale values in iodine staining were significant between the HPV18 and the other groups (P < 0.05). The frequency of the occurrence of the coarse mosaic patterns was significantly different among groups (P < 0.05), reducing in sequence were the HPV16, HPV-negative, HPV18, HPV31/33 and HPV52/58 groups. For the lesion area of HSILs, the HPV-negative group was the largest. The sensitivity of colposcopic impression varied among HPV genotypes (P < 0.01), being lowest in the HPV52 group. Conclusions Although being nonspecific, iodine negativity should be concerned in HPV18-positive lesions which is closely related to glandular epithelium. Vascular patterns in HPV52/58-positive HSIL are quite occult and tend to be missed by colposcopists. HPV-negative lesions are prone to be large and present typical vascular patterns despite being rare.
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Affiliation(s)
- Qi Zhou
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Yingxin Gong
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Xiangmei Qiu
- The First Affiliated Hospital of Zunyi Medical College, Guizhou, 563000, China
| | - Long Sui
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Hongwei Zhang
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Yan Wang
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Lin Lin
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Wenjing Diao
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China
| | - Yanyun Li
- Obstetrics and Gynecology Hospital of Fudan University, 419 Fangxie Road, Shanghai, 200011, China.
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Bai A, Wang J, Li Q, Seery S, Xue P, Jiang Y. Assessing colposcopic accuracy for high-grade squamous intraepithelial lesion detection: a retrospective, cohort study. BMC Womens Health 2022; 22:9. [PMID: 35012523 PMCID: PMC8751223 DOI: 10.1186/s12905-022-01592-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/31/2021] [Indexed: 01/03/2023] Open
Abstract
Background Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+ cases and to analyze the associated clinical factors. Methods Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists’ competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard. Results Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+ cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion/carcinoma. Conclusion Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.
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Affiliation(s)
- Anying Bai
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Jiaxu Wang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Qing Li
- Diagnosis and Treatment for Cervical Lesions Center, Shenzhen Maternity & Child Healthcare Hospital, Shenzhen, 518028, China
| | - Samuel Seery
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, LA1 4YW, UK
| | - Peng Xue
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
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Zhang B, Hong S, Zhang G, Rong F. Clinical application of the 2011 IFCPC colposcope terminology. BMC WOMENS HEALTH 2021; 21:257. [PMID: 34167543 PMCID: PMC8223298 DOI: 10.1186/s12905-021-01395-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 06/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colposcopy offers an accurate way to the diagnose of cervical precancerous lesions. However, the diagnostic accuracy of colposcopy is unsatisfied. This study was to evaluate colposcopic accuracy according to the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology. METHODS A retrospective cohort study was performed in 1,838 patients who underwent colposcopy in Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University from October 2013 to April 2018. Using conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated, and correlations between variables were analyzed. RESULTS As an authoritative and widely used terminology for colposcopy diagnosis, the 2011 IFCPC terminology has certain clinical practicality and diagnostic accuracy. However, some signs such as mosaic, punctation, sharp border, inner border sign and ridge sign had high specificity but unsatisfactory sensitivity, which limited the diagnostic value. Therefore, we discussed the Lugol's staining, a very common sign in colposcopy, and analyzed the diagnostic significance of bright yellow staining in low-grade squamous intraepithelial lesion (LSIL) and mustard yellow staining in high-grade squamous intraepithelial lesion (HSIL). The results showed that mustard yellow may be a valuable indicator in the diagnosis of HSIL. CONCLUSION The 2011 IFCPC colposcope terminology has standardized interpretations of the colposcopic findings and improved the accuracy of colposcopy diagnosis. The aceto-white epithelium still has important diagnostic value; however, the value of a few signs is needed to be discussed and new signs are expected to be discovered. Although the significance of Lugol's staining was diminishing, mustard yellow might be a valuable indicator for the diagnosis of HSIL.
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Affiliation(s)
- Bei Zhang
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, No.16766, Jingshi Road, Jinan, 250014, Shandong Province, China
| | - Shuhui Hong
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, No.16766, Jingshi Road, Jinan, 250014, Shandong Province, China
| | - Guihui Zhang
- Department of Pathology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250014, Shandong, China
| | - Fengnian Rong
- Department of Obstetrics and Gynecology, Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, No.16766, Jingshi Road, Jinan, 250014, Shandong Province, China.
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Li J, Wang W, Yang P, Chen J, Dai Q, Hua P, Liu D. Analysis of the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy in a single tertiary center of Chengdu. Arch Gynecol Obstet 2021; 304:1033-1041. [PMID: 33683424 DOI: 10.1007/s00404-021-06012-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 02/23/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of this retrospective study was to analyze the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy. METHODS The medical records of patients underwent a colposcopy-guided cervical biopsy at Chengdu Women's and Children's Central Hospital between January 2017 and January 2019 were collected, including age, menopausal status, cervical cytology and human papillomavirus (HPV) test results, type of transformation zone, colposcopic diagnosis and histopathological outcomes of cervical biopsy. Colposcopy was carried out using 2011 colposcopic terminology of International Federation for Cervical Pathology and Colposcopy (IFCPC). Related variables were analyzed. RESULTS A total of 495 patients were collected in this study. The perfect agreement between colposcopic impression and histopathological diagnosis was 46.9%, and the strength of agreement with kappa value was 0.283 (P < 0.001), and the agreement within 1 grade was 93.5%. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, false-positive rate and false-negative rate of detecting HSIL or more (HSIL +) were 93.1%, 57.8%, 80.9%, 93.9%, 6.1% and 45.3%, respectively. Colposcopic diagnosis more often underestimated (43.2%) [especially in HSIL (59.3%) and carcinoma (70.7%) patients] than overestimated (9.9%) in cervical lesions. The results of cytology, HPV status, patients' age and different experiences of practitioners were the factors for under-diagnosis of HSIL + by colposcopy. CONCLUSION Colposcopy is an excellent tool to estimate cervical high-grade lesion but is imprecise. Many factors can bias the diagnosis of colposcopy, especially the known results of cervical cytology and HPV. Precise diagnosis of cervical lesion should rely on the colposcopy-directed biopsy.
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Affiliation(s)
- Juan Li
- Department of Diagnosis and Treatment for Vulval and Cervical Diseases, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Wei Wang
- Department of Diagnosis and Treatment for Vulval and Cervical Diseases, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China.
| | - Ping Yang
- Chengdu Branch of the China Electronics Technology Group Corporation, Big Data Research Institute Co., Ltd. Chengdu, Sichuan, 610000, China
| | - Jing Chen
- Department of Diagnosis and Treatment for Vulval and Cervical Diseases, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Qianling Dai
- Department of Diagnosis and Treatment for Vulval and Cervical Diseases, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Ping Hua
- Department of Pathology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
| | - Dandan Liu
- Department of Diagnosis and Treatment for Vulval and Cervical Diseases, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China
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Zhou Q, Zhang F, Sui L, Zhang H, Lin L, Li Y. Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology on the Detection of Vaginal Intraepithelial Neoplasia. Cancer Manag Res 2020; 12:5987-5995. [PMID: 32765098 PMCID: PMC7373405 DOI: 10.2147/cmar.s257875] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/24/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the colposcopic accuracy of the detection of vaginal intraepithelial neoplasia (VaIN) according to the colposcopic terminology for the vagina from the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC). Methods A total of 467 women who were suspected of having VaIN and underwent colposcopy at Obstetrics and Gynecology Hospital of Fudan University from January to December 2018 were included in this retrospective cohort study. The 2011 IFCPC revised terminology for the vagina was applied, and the agreement between colposcopic diagnosis and vaginal biopsy pathology was analysed. Results Agreement between colposcopy and pathology was 69.16% (kappa=0.437, p<0.001), with 23.34% overestimated and 7.49% underestimated diagnosis for colposcopy. The agreement was the lowest (35.71%) in the high-grade VaIN group, which was significantly different from that of other lesion grade groups (p<0.01). Among grade 1 findings, thin acetowhite epithelium was the most frequent (80.51%). Grade 2 findings and vascular patterns were rare. The positive predictive values of the micropapillary pattern were 55.98% for low-grade VaIN and 5.98% for high-grade VaIN. The specificity of iodine negativity was 10.92% for low-grade VaIN and 8.30% for high-grade VaIN. There were significant differences in the maximum size of single lesions and in the number of lesions among different grade lesion groups. Conclusion The agreement between colposcopy findings utilizing the 2011 IFCPC terminology and vaginal pathology is moderate, and more definite findings for high-grade VaIN may be needed. The micropapillary pattern can be considered an alternative low-grade finding, while iodine staining is nonspecific for all lesions. Scattered and spotty lesions suggest low-grade VaIN, while large single lesions suggest high-grade VaIN.
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Affiliation(s)
- Qi Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Feifei Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Long Sui
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Hongwei Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Lin Lin
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
| | - Yanyun Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, People's Republic of China
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