Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis

Abstract

Background The colposcopy-directed punch biopsy is widely used in the management of women with abnormal cervical cytology; however, its accuracy compared with definitive histology from an excision biopsy is not well established.Objectives To assess the accuracy of the colposcopy-directed punch biopsy to diagnose high-grade cervical intraepithelial neoplasia (CIN) by performing a systematic review and meta-analysis.Search strategy A systematic search of MEDLINE, EMBASE and the Cochrane Library was performed.Selection criteria Articles that compared the colposcopically directed cervical punch biopsy with definitive histology from an excisional cervical biopsy or hysterectomy.Data collection and analysis Random effects and hierarchical summary receiver operating characteristic regression models were used to compute the pooled sensitivity and specificity applying different test cut-offs for outcomes of high-grade CIN.Main results Thirty-two papers comprising 7873 paired punch/ definitive histology results were identified. The pooled sensitivity for a punch biopsy defined as test cut-off CIN1+ to diagnose CIN2+ disease was 91.3% (95% CI 85.3-94.9%) and the specificity was 24.6% (95% CI 16.0-35.9%). In most of the studies, the majority of enrolled women had positive punch biopsies. Pooling of the four studies where the excision biopsy was performed immediately after the punch biopsy, and where the rate of positive punch biopsies was considerably lower, yielded a sensitivity of 81.4% and specificity of 63.3%.Author's conclusion The observed high sensitivity of the punch biopsy derived from all studies is probably the result of verification bias.

Clinicopathologic Importance of Women with Squamous Cell Carcinoma Cytology on Siriraj Liquid-Based Cervical Cytology

“…In cases of CIN 2-3, colposcopy missed to diagnose at the rate of underestimation was 57%, and the overestimation rate by Reid Index scoring was 70% (Massad et al, 2009;Stoler et al, 2011). Recent systematic review and meta-analysis stated that colposcopic biopsies yielded a sensitivity of 81.4% and specificity of 63.3% for CIN2-3 detection (Underwood et al, 2012).…”

Agreement between Colposcopic Diagnosis and Cervical Pathology: Siriraj Hospital Experience

“…The agreement within one-step between the colposcopic impression and histology was found in 75-77% (Massad and Collins, 2003;Baum et al, 2006). The colposcopy alone is known to under diagnose approximately one-third of HSIL (Underwood et al, 2012).…”

El método CONO-UC: un protocolo integrado de toma de decisión y manejo de lesiones pre-invasoras del cuello uterino útil para especialistas jóvenes.

“…Esto se ha vuelto cada vez más importante con la creciente conciencia de la morbilidad relacionada con el embarazo asociada con procedimientos del tipo excisional [12]. Un meta-análisis reciente mostró que la alta sensibilidad observada con biopsias por mascada, obtenida desde todos los estudios, es probablemente el resultado de sesgo de verificación [13]. En la mayoría de estos estudios, la mayoría de las mujeres inscritas tenían biopsias por mascada positivas.…”

“…En la mayoría de estos estudios, la mayoría de las mujeres inscritas tenían biopsias por mascada positivas. La agrupación de los cuatro estudios en los que se realizó la conización inmediatamente después de la biopsia por mascada y donde el porcentaje de biopsias por mascada positivas fue considerablemente menor, derivó en una sensibilidad del 81,4% y una especificidad del 63,3% [13]. A pesar de la mejora obtenida con la introducción de la terminología internacional de la colposcopia y la patología cervical en términos de acuerdo entre la impresión a la colposcopia y el diagnóstico histológico [14], el número de sobrevaloración del diagnóstico colposcópico sigue siendo alto, alrededor del 20% [15].…”