An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy

Baldauf, Jean-Jacques; Dreyfus, Michel; Ritter, J; Philippe, E

doi:10.3109/00016349709047830

Cited by 47 publications

(39 citation statements)

References 19 publications

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“…The results of another German study were very similar to ours (85.8 %) with regard to histological agreement [10]. Baldauf et al also reported a very high agreement (89.6 %) between biopsy and conization results (overestimation 4.6%) [11].…”

supporting

confidence: 77%

“…The correlation between biopsy and histology decreased with increasing age (highest agreement for patients < 30 years; lowest agreement in patients aged > 50 years). Other studies have reported similar findings, with a lower rate of agreement for patients aged > 50 years [11]. Patients in the age group > 50 years are more likely to be postmenopausal and have a type 3 transformation zone, which results in a higher rate of colposcopies which are difficult to assess and a lower rate of agreement between the diagnosis based on colposcopy and the histology results [23].…”

supporting

confidence: 50%

“…Studies have reported complete agreement in between 45 and 89.6 % of cases. Agreement within one histological grade was present in between 74 and 89.9 % of cases [5][6][7][8][9][10][11]. The crucial issue is to determine which conditions and factors can influence the accuracy of biopsy findings.…”

Section: Accuracy Of Colposcopically Guided Diagnostic Methods For Thmentioning

confidence: 99%

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Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Müller

Soergel

Hillemanns

et al. 2016

Geburtshilfe Frauenheilkd

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!Introduction: Many factors can affect the accuracy of colposcopically guided biopsy, endocervical curettage (ECC) and differential cytology, all of which are standard, minimally invasive procedures used to detect cervical intraepithelial neoplasia. Method: All conizations carried out between 2007 and 2013 in the gynecological department of Hannover Medical School were retrospectively reviewed. The agreement between colposcopic diagnosis and histology was evaluated retrospectively. The analysis included 593 complete datasets out of a total of 717 cases treated. Results: The overall agreement was 85.5 %; the accuracy was significantly higher (p = 0.029) when three biopsy specimens were taken rather than just one. The agreement between diagnosis and histological findings from conization was highest for women < 30 years (90.7%) and lowest for women > 50 years (72.1%; p = 0.008). The agreement between preoperative differential cytology and histology results after conization was 86.7 % and improved as patient age increased (p = 0.035). The agreement between ECC findings and the results of conization was only 49.1 % irrespective of patient age, transformation zone or the patientʼs menopausal status. Conclusion: The accuracy of colposcopically guided biopsy appears to increase when three biopsy specimens are taken and is particularly high for younger patients. Differential cytology was also found to be highly accurate and is particularly useful for patients aged more than 50 years. The accuracy of ECC was significantly lower; however ECC can provide important additional information in selected cases.

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supporting

confidence: 77%

supporting

confidence: 50%

Section: Accuracy Of Colposcopically Guided Diagnostic Methods For Thmentioning

confidence: 99%

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Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Müller

Soergel

Hillemanns

et al. 2016

Geburtshilfe Frauenheilkd

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“…[36][37][38][39][40] This review illustrates the validity of colposcopy as it is used in the everyday clinical setting. It has tried to eliminate possible sources of bias due to patient selection, intervention methodology and outcome measure bias as much as possible while trying to aggregate a homogenous collection of patients suitable for such analysis.…”

Section: Discussionmentioning

confidence: 99%

Validity of Colposcopy in the Diagnosis of Early Cervical Neoplasia: A Review

Olaniyan

2002

African Journal of Reproductive Health

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This study was conducted to quantify by meta-analysis the validity of colposcopy in the diagnosis of early cervical neoplasia in order to assess the justification of its integral role in this regard. Eight longitudinal studies were selected, which compared correlation of colposcopic impression with colposcopically directed biopsy results. The prevalence of disease in the studies ranged from 40 to 89%. Colposcopic accuracy was 89%, which agreed exactly with histology in 61% of cases. The sensitivity and specificity of colposcopy for the threshold normal versus all cervical abnormalities were 87-99% and 26-87% respectively. For the threshold normal and low grade SIL versus high grade SIL, the values were 30-90% and 67-97%. Likelihood ratios increased with disease severity. Colposcopy performed better in differentiation of high grade from low grade disease than in differentiation of low grade disease from normal cervix. Colposcopy is a valid tool for the diagnosis of early cervical neoplasia. RÉSUMÉLa validité de la colposcopie dans le diagnostic de la néoplasie cervicale précoce: compte rendu. Cette étude avait pour but de quantifier, à l'aide de l'analyse meta, la validité de la colposcopie dans le diagnostic de la néoplasie cervicale précose afin d'évaluer la justification de son rôle intégrant à cet égard. Huit études longitudinales ont été selectionnées pour comparer la corrélation de l'empreinte colposcopique avec les résultats de la biopsie colposcopiquement orientées. La prévalence de la maladie dans les études variait de 40% à 89%. La précision colposcopique était 89%, ce qui s'accorde avec l'histologie dans 61% de cas. La sensibilité et la spécificité de la colposcopie pour le seuil normal par rapport à toutes les anormalités cervicales étaient 87-99% et 26-89% respectivement. En ce qui concerne le seuil normal et le SIL de qualité inférieure par rapport à SIL de haute qualité, les valeurs étaient 30-90% et 67-97%. L'indice de probabilité a augmenté avec la sévérité de la maladie. La performance de la colposcopie était meilleure quant à la différenciation d'une maladie de haut degré d'une maladie de degré inférieur, que dans la différenciation d'une maladie de degré inférieur du cou normal. La colposcopie demeure un outil valable pour le diagnostic de la néoplasie cervicale précoce. Son rôle intégrant dans le traitement de la maladie cervicale précoce est donc justifié. (Rev Afr Santé Reprod 2002; 6[3]: 59-69)

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“…Albeit less frequent, underestimations may have even more serious implications. The greatest concern is that early invasive lesions may be missed and inadvertently treated by an ablative technique [1,2]. Disease relapse in such patients has been described [3].…”

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confidence: 99%

The Correlation of cervical intraepithelial neoplasia 3 detected by cervical punch biopsies with the pathologic results of conization and hysterectomy

Kim

Park

et al. 2011

Korean J Obstet Gynecol

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ObjectiveTo know the correlation of punch-biopsy proven cervical intraepithelial neoplasia (CIN) 3 with the results of cone and hysterectomy. MethodsWe reviewed the medical records from 1999 to 2008, retrospectively, at a single institution. We checked age, cone and hysterectomy biopsy results, preoperative cervical smear results as well as human papillomavirus results. ResultsThere were 104 patients whose punch biopsy results were CIN 3. 59 (56.7%) patients underwent cone and 45 did hysterectomy after punch biopsies. Cone found 6.8% of cervical cancer. Among patients undergoing hysterectomy without cone, 8.9% had cervical cancers. There were a lot of inflammations, atypical squamous cells of unknown significance, low-grade squamous intraepithelial lesion done as a Pap results just before cone. The positive rate of HPV was 80.0%. There were 5.1% of underestimated and 6.8% of over-estimated results according to the cone results, and 6.7% of under-estimated and 8.9% of overestimated according to the hysterectomy results. ConclusionThrough conization, 93.2% of the patients whose punch biopsy results were CIN 3 had CIN and did not need hysterectomy, and 6.8% had cervical cancers and might need further treatment. Through hysterectomy, 91.2% had CIN and might undergo overtreatment. Limited accuracy of punch biopsy of the cervix in defi ning extent and severity of epithelial lesions in women presenting with abnormal Pap smear remains an important clinical problem. Studies correlating the histology diagnosis of biopsy with that of the surgical specimen showed both under-and over-estimations. Biopsy diagnoses that overestimate the grade of cervical intraepithelial neoplasia (CIN) are associated primarily with potential overtreatment. Albeit less frequent, underestimations may have even more serious implications. The greatest concern is that early invasive lesions may be missed and inadvertently treated by an ablative technique [1,2]. Disease relapse in such patients has been described [3]. The

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An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy

Abstract: To ensure that a microinvasive cancer has not been overlooked, the excision of high-grade CINs seems to be justified, whatever the clinical status and the colposcopic aspect.

Cited by 47 publications

References 19 publications

Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Validity of Colposcopy in the Diagnosis of Early Cervical Neoplasia: A Review

The Correlation of cervical intraepithelial neoplasia 3 detected by cervical punch biopsies with the pathologic results of conization and hysterectomy

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