Diagnostic value of colposcopy in patients with cytology-negative and HR-HPV-positive cervical lesions

Liu, Yang; Liao, Jing; Yi, Xiaojia; Pan, Zhengmei; Pan, Jing; Sun, Chuanyu; Zhou, Honglin; Meng, Yushi

doi:10.1007/s00404-022-06415-5

Cited by 6 publications

(7 citation statements)

References 32 publications

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“…The threshold for referring to colposcopy will be in the centre of discussion for a while since it is based on accepted cervical cancer risk, the population real-world screening data and screening capacity [42,43]. In another report, the detection rate of CIN2 + in patients with normal cytology was higher, but that might be based on a selection bias since not all patients received colposcopy and colposcopy -directed biopsies in that study [31]. Another possible explanation is the high quality of screening cytology in the region with low rates of under-diagnosis.…”

Section: Discussionmentioning

confidence: 97%

“…Previous studies have mostly been concerned with concordance rates between the different diagnostic tools and respective consistency rates [18,[31][32][33][34]. In clinical practice, it is the combination of all diagnostic tools that is routinely used and we sought to find the best predictors of CIN2 + in the patient collective of hrHPV-positive/cytology negative or low-grade cytologic abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…In another report, the detection rate of CIN2 + in patients with normal cytology was higher, but that might be based on a selection bias since not all patients received colposcopy and colposcopy -directed biopsies in that study [ 31 ]. Another possible explanation is the high quality of screening cytology in the region with low rates of under-diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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CIN2 + detection in high-risk HPV patients with no or minor cervical cytologic abnormalities: a clinical approach validated by machine learning

Wittenborn

Kupec

Iborra

et al. 2023

Arch Gynecol Obstet

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Purpose To evaluate the feasibility and diagnostic value of the combination of colposcopy, cytology and hrHPV (high-risk human papilloma virus) PCR (polymerase chain reaction) testing in patients with no or minor cytologic abnormalities and HPV high risk infection and to find the best predictors for the presence of CIN2 + in this patient collective. Methods Three hundred and thirty-four hrHPV patients with normal cytology or minor cytologic abnormalities who had a colposcopic examination at the center of colposcopy at the university hospital Aachen in 2021 were enrolled in this retrospective cohort analysis. Multivariate logistic regression and a machine-learning technique (random forests, leave-one-out analysis) were used. Results The overall risk for CIN2 + in hrHPV-positive patients with normal cytology was 7.7% (N = 18) (5% for CIN3 +), 18% (N = 16) (10.1% for CIN3 +) in patients with PAP IIp (ASC-US) and 62.5% (N = 5) (25% for CIN3 +) in patients with PAP IIg (AGC). Variables that show a statistically significant influence for the CIN-status are ‘major change’ as the result of colposcopy, transformation zone type T1, PAP IIg upon referral (AGC) and hrHPV category 1a (HPV 16/18) detection. Using machine learning (random forests) techniques, the main influencing variables were confirmed. A monotonously decreasing risk for CIN2 + from hrHPV category 1a to 3 (in accordance to the IACR guidelines) was found. Conclusion In the collective of hrHPV patients with no or minor cytologic abnormalities, the result of colposcopy and HPV PCR status are key predictors for the detection of CIN2 + with a monotonously decreasing risk for CIN2 + from hrHPV category 1a to 3.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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CIN2 + detection in high-risk HPV patients with no or minor cervical cytologic abnormalities: a clinical approach validated by machine learning

Wittenborn

Kupec

Iborra

et al. 2023

Arch Gynecol Obstet

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“…However, colposcopy has certain limitations. For example, physicians observe the changes of the cervical epithelium under the action of acetic acid in just a few minutes during a patient's examination, which is subjective, and changes in the cervical epithelium may also be affected by factors such as solution application method, volatilization degree and action time, which may lead to misdiagnosis and missed diagnosis ( 40 , 41 ). The present study demonstrated that the accuracy and positive predictive value of colposcopy in the diagnosis of cervical cancer and precancerous lesions were both high, but the negative predictive value of colposcopy was low, which suggested that false negative phenomenon could be expected to occur in the diagnosis of cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

Value of high‑risk human papillomavirus detection combined with colposcopy in the diagnosis of cervical cancer and precancerous lesions

Wang,

Gao,

et al. 2024

Oncol Lett

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In the present study, the diagnostic value of high risk-human papillomavirus (HR-HPV) combined with colposcopy for the detection of cervical cancer and precancerous lesions was evaluated. A total of 397 patients with confirmed cervical disease were enrolled between August 2020 and December 2021. According to the pathological diagnosis, the patients were divided into cervical intraepithelial neoplasia grade I (CIN I; n=153 cases), CIN II (n=101 cases), CIN III (n=86 cases) and cervical cancer (n=57 cases) groups. The HR-HPV-positive rate of the patients with different lesion types was compared, and the consistency of colposcopy and pathological examination results were assessed. For cervical cancer and precancerous lesions, the diagnostic value and efficacy of HR-HPV testing, colposcopy and combined HR-HPV testing and colposcopy examination were compared using pathological examination results as the gold standard. The results of the present study demonstrated that in patients with cervical cancer, the positive rate of HR-HPV (100.00%; n=57/57) was higher than that in patients with precancerous lesions, and the positive rate of HR-HPV in patients with CIN I type (36.60%, n=56/153) was lower than that in patients with CIN II (83.17%, n=84/101) and CIN III (82.56%, n=71/86) types (P<0.05). There was no significant difference in the HR-HPV-positive rate between patients with CIN II and CIN III (P>0.05). Cohen's κ coefficient for colposcopy examination and pathological examination of patients with cervical cancer and precancerous lesions was 0.622, the diagnostic accuracy was 90.43% (n=359/397), the positive predictive value was 65.57% (n=40/61), and the negative predictive value was 94.94% (n=319/336). Receiver operating characteristic curve analysis demonstrated that the area under the curve of the combined examination in the diagnosis of cervical cancer and precancerous lesions was 0.904, which was higher than that of colposcopy (0.820) or HR-HPV testing (0.802) alone (P<0.05). The results of the present study indicated that HR-HPV detection combined with colposcopy has diagnostic value for cervical cancer and precancerous lesions.

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“… 3 The US Preventive Services Task Force recommends directly referring women infected with HPV16/18 for coloscopy. Non‐16/18 hrHPV women would be triaged for cytology, 4 , 5 , 6 while only cases of positive cytology could be identified through this approach. Given the relatively varied sensitivity of cytologic screening, 7 , 8 current guidelines increase the number of related missed opportunities to intervene earlier in the course of this insidious disease.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of high‐risk HPV other than type 16/18 in high‐grade cervical neoplasia among cytology‐negative women: A multicenter retrospective study

Bai

Xue

et al. 2023

Cancer Medicine

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Background: Human papillomavirus (HPV) is a necessary cause of cervical cancer, and a tool more sensitive than cytology for the early screening of cervical precancers. The two most carcinogenic genotypes HPV 16/18 have been reported in the majority of studies. High-risk HPVs other than HPV 16/18 (non-16/18-hrHPVs) cause approximately a quarter of cervical cancers, and we aimed to analyze the genotype-specific prevalence, risk and diagnostic efficiency of non-16/18-hrHPVs in cervical carcinogenesis among Chinese cytology-negative women.Methods: A total of 7043 females who had abnormal cervical testing results from January 2018 to October 2021 were enrolled, among them 3091 were cytologynegative. Descriptive statistics was used to estimate the HPV genotype-specific prevalence, and multivariable logistic regression was used to estimate the genotype-specific non-16/18 hrHPVs risk of cervical carcinogenesis. The evaluation of diagnostic value among HPV genotypes included the possibility of predicting cervical intraepithelial neoplasia grade 2/3 or worse (CIN2+/CIN3+) and the diagnostic efficiency measured by increased referral rate and referral numbers of colposcopies per additional CIN2+/CIN3+ detected. Results: Among HPV-positive cytology-negative women, the five dominant genotypes for CIN2+/CIN3+ were HPV 31/33/35/52/58. HPV 52/58/33 had comparatively high sensitivity and specificity in predicting CIN2+/CIN3+, while the referral strategy of multiple HPV58 required 26 colposcopies to detect 1 CIN3+, compared with 14, 12, and 8 required by multiple HPV52, 31, and 33, respectively.Conclusions: HPV31/33/35/52/58 infections are significant risk factors for cervical lesions, and multiple HPV 31/33/52 infections should be included in the previously recommended HPV16/18 genotyping triage for colposcopy in China, as the benefits of disease prevention may outweigh the disadvantages of increasing requirements for colposcopy services.

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Diagnostic value of colposcopy in patients with cytology-negative and HR-HPV-positive cervical lesions

Cited by 6 publications

References 32 publications

CIN2 + detection in high-risk HPV patients with no or minor cervical cytologic abnormalities: a clinical approach validated by machine learning

CIN2 + detection in high-risk HPV patients with no or minor cervical cytologic abnormalities: a clinical approach validated by machine learning

Value of high‑risk human papillomavirus detection combined with colposcopy in the diagnosis of cervical cancer and precancerous lesions

Diagnostic value of high‐risk HPV other than type 16/18 in high‐grade cervical neoplasia among cytology‐negative women: A multicenter retrospective study

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