Gynaecological oncology: The role of colposcopy in the follow up of women treated for cervical intraepithelial neoplasia

Abstract

Objective To determine the effect of colposcopy on the sensitivity and specificity of follow-up procedures in the detection of residual or recurrent disease after treatment for cervical intraepithelial neoplasia (CIN).Design A retrospective study of information held in a colposcopy database.Setting A teaching hospital colposcopy clinic. Main outcome measures The sensitivity and specificity of cytology alone was compared with the sensitivity and specificity of the combination of colposcopy and cytology.Results Colposcopy improved the sensitivity of cytology for the detection of high-grade disease from 64 to 91% but reduced the specificity from 95 to 88%. With a 3% rate of post-treatment highgrade disease, colposcopy detected 8 extra cases per 1000 women but resulted in 88 more false alarms per 1000 women. Among women in whom the treatment margins were involved or uncertain, colposcopy detected 13 extra cases per 1000 women but resulted in 12 fewer false alarms per 1000 women because the prevalence of post-treatment disease was higher.Conclusions Colposcopy does improve the detection rate of posttreatment disease but at a cost of additional false alarms. The benefit of colposcopy will be greater in high-risk groups of women with higher rates of treatment failure.Keywords CIN, colposcopy, cytology, recurrence, sensitivity.Please cite this paper as: Soutter W, Butler J, Tipples M. The role of colposcopy in the follow up of women treated for cervical intraepithelial neoplasia. BJOG 2006; 113:511-514.

Cytological Follow-up of Women Older than 50 Years With High-Grade Cervical Smear Treated by Large Loop Excision

“…Soutter et al [8] in a large patient analysis of women after loop biopsy found that addition of colposcopy to cytological surveillance in the follow-up schedule of high-risk women would have identified only 13 extra cases of high-grade CIN with 76 extra false positives per 1,000 women. These authors recommend prolonged colposcopic follow-up for this high-risk group, suggesting that colposcopy would identify recurrent CIN earlier; not that cytological surveillance would miss disease, but would take about 5 annual smears to reduce undetected post-treatment disease to 1%.…”

Seguimiento citológico de mujeres de más de 50 años con citología cervical de alto grado tratadas con escisión con asa

“…[8], en un amplio análisis de mujeres tras una biopsia con asa, observaron que la adición de la colposcopia a la vigilancia citológica en la pauta de seguimiento de las mujeres de alto riesgo hubiera identificado tan solo 13 casos adicionales de CIN de alto grado, con 76 falsos positivos adicionales por cada 1.000 mujeres. [8], en un amplio análisis de mujeres tras una biopsia con asa, observaron que la adición de la colposcopia a la vigilancia citológica en la pauta de seguimiento de las mujeres de alto riesgo hubiera identificado tan solo 13 casos adicionales de CIN de alto grado, con 76 falsos positivos adicionales por cada 1.000 mujeres.…”

Guía de cribado del cáncer de cuello de útero en España, 2014

“…Las mujeres con antecedente de CIN2+ tratado o con resolución espontánea en los últimos 20 años siguen teniendo un riesgo de sufrir un CCU entre 5 y 10 veces mayor que la población general 128,129 . Por esta razón, en muchos países se recomienda el seguimiento más frecuente en los primeros años postratamiento y seguir con cribado citológico cada 3 años o con prueba de VPH o co-test cada 5 años hasta los 20 años, independientemente de que la mujer haya cumplido los 65 años 47,69,130 .…”