Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen

Zuchna, Christian; Hager, Martina; Tringler, Barbara; Georgoulopoulos, Alexander; Ciresa-Koenig, Alexandra; Volgger, Birgit; Widschwendter, Andreas; Staudach, A.

doi:10.1016/j.ajog.2010.05.033

Cited by 78 publications

(81 citation statements)

References 24 publications

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“…In our study, the agreement between biopsy findings and the final histological results after conization was 85.5 % which is significantly higher than the correlation reported in other studies [3,[5][6][7][8][9]. Those studies predominantly recorded whether there was a precise agreement between biopsy and conization results; they might have reported a higher correlation if overestimated results had been grouped together with precise agreement.…”

contrasting

confidence: 80%

“…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%

“…The crucial issue is to determine which conditions and factors can influence the accuracy of biopsy findings. One study has already shown that patient age can be a factor which will affect the accuracy of the biopsy [6]. This raises the questions whether the correlation between biopsy findings and final histology will be affected if a greater number of biopsies is taken and whether there is a connection between the correct histology and the experience of the colposcopist.…”

Section: Accuracy Of Colposcopically Guided Diagnostic Methods For Thmentioning

confidence: 99%

“…The highest sensitivity for the detection of high-grade dysplasia as reported in a study by Wentzensen et al was 95.6 % after taking three biopsies; the figure dropped to 85.6 % after two biopsies and to 60.6 % if only one biopsy was taken [20]. Another study only showed an increase in sensitivity after taking a second biopsy, with no further improvements reported after taking a third biopsy [6]. Factors affecting the number of biopsies taken include the size and the overall impression of the lesions obtained during colposcopy.…”

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confidence: 85%

“…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]. In contrast to these studies, Zuchner et al described the opposite finding, with the sensitivity of biopsies increasing as patient age increased [6].…”

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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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confidence: 80%

Section: Accuracy Of Colposcopically Guided Diagnostic Methods For Thmentioning

confidence: 99%

Section: Accuracy Of Colposcopically Guided Diagnostic Methods For Thmentioning

confidence: 99%

mentioning

confidence: 85%

mentioning

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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Concordance ofHPV, conventional smear, colposcopy, and conization results in cervical dysplasia

Kırmızı

Başer

Çaltekin

et al. 2020

Diagnostic Cytopathology

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Background Cervical cancer screening algorithms are increasingly focused on Human Papillomavirus (HPV)‐based screening while the accuracy of using abnormal cytological findings to detect dysplastic lesions still remains important. This retrospective study correlated the results of conventional cervical cytology, colposcopy guided biopsy, and cold knife conization (CKC) procedures performed in a tertiary center. Materials and Methods Data from 9399 patients who underwent screening with conventional cervical cytology between 2010 and 2019 was obtained from the hospital registry. Abnormal cervical cytology and high‐risk HPV DNA genotypes were recorded and their colposcopic and CKC pathology was determined. Results Two hundred and ninety two patients underwent colposcopy for abnormal cervical cytology and/or high‐risk HPV positivity. One hundred and twenty three patients were positive for High‐risk HPV. Abnormal cervical cytology was detected in 216 patients. The most common cytological anomaly was atypical squamous cells of undetermined significance (ASCUS) found in 9399 patients (1.39%). It was determined that conventional cytology had a sensitivity of 70.8% and a specificity of 62.2% for the detection of low‐grade lesions, while it had a sensitivity of 72.4% and a specificity of 86.0% for the detection of high‐grade lesions. CKC was applied to 68 patients who were diagnosed with high‐grade squamous intraepithelial lesions (HSIL) as a result of the colposcopy. As a result of CKC, a high‐grade lesion was detected in 73.5% of these patients. Conclusion Conventional cervical cytology and colposcopy exhibited higher accuracy as the severity of lesions increased. Detection of HPV may prevent unnecessary surgical procedures, especially with ASCUS.

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Reducing overtreatment associated with overdiagnosis in cervical cancer screening—A model‐based benefit–harm analysis for Austria

Sroczynski¹,

Esteban²,

Widschwendter

et al. 2020

Intl Journal of Cancer

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A general concern exists that cervical cancer screening using human papillomavirus (HPV) testing may lead to considerable overtreatment. We evaluated the trade‐off between benefits and overtreatment among different screening strategies differing by primary tests (cytology, p16/Ki‐67, HPV alone or in combinations), interval, age and diagnostic follow‐up algorithms. A Markov state‐transition model calibrated to the Austrian epidemiological context was used to predict cervical cancer cases, deaths, overtreatments and incremental harm–benefit ratios (IHBR) for each strategy. When considering the same screening interval, HPV‐based screening strategies were more effective compared to cytology or p16/Ki‐67 testing (e.g., relative reduction in cervical cancer with biennial screening: 67.7% for HPV + Pap cotesting, 57.3% for cytology and 65.5% for p16/Ki‐67), but were associated with increased overtreatment (e.g., 19.8% more conizations with biennial HPV + Papcotesting vs. biennial cytology). The IHBRs measured in unnecessary conizations per additional prevented cancer‐related death were 31 (quinquennial Pap + p16/Ki‐67‐triage), 49 (triennial Pap + p16/Ki‐67‐triage), 58 (triennial HPV + Pap cotesting), 66 (biennial HPV + Pap cotesting), 189 (annual Pap + p16/Ki‐67‐triage) and 401 (annual p16/Ki‐67 testing alone). The IHBRs increased significantly with increasing screening adherence rates and slightly with lower age at screening initiation, with a reduction in HPV incidence or with lower Pap‐test sensitivity. Depending on the accepted IHBR threshold, biennial or triennial HPV‐based screening in women as of age 30 and biennial cytology in younger women may be considered in opportunistic screening settings with low or moderate adherence such as in Austria. In organized settings with high screening adherence and in postvaccination settings with lower HPV prevalence, the interval may be prolonged.

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Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen

Cited by 78 publications

References 24 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

Concordance ofHPV, conventional smear, colposcopy, and conization results in cervical dysplasia

Reducing overtreatment associated with overdiagnosis in cervical cancer screening—A model‐based benefit–harm analysis for Austria

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