Pathologic discrepancies between colposcopy-directed biopsy and loop electrosurgical excision procedure of the uterine cervix in women with cytologic high-grade squamous intraepithelial lesions

Kim, Se Jeong; Suh, Dong Hoon; Kim, Kidong; No, Jae Hong; Kim, Yong Beom

doi:10.3802/jgo.2020.31.e13

Cited by 23 publications

(27 citation statements)

References 30 publications

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“…In the same study, it was emphasized that in various studies that it is difficult to differentiate LSIL and HSIL with colposcopic cervical biopsy, and therefore pathologists use immune-histochemical staining for cases in-between [25,26]. In addition, like our results, all these studies indicate that the consistency between smear and histologic results increases for more invasive lesions of the cervix [19,[23][24][25][26][27].…”

Section: Discussionsupporting

confidence: 81%

“…A prospective study shows that colposcopic biopsy results report lower rates of HSIL than LEEP [24]. In the study of Kim and et al [24], in terms of HPV detection, 67.7% concordance was found between colposcopic biopsy and LEEP results and 26.6% of the colposcopic biopsy results was under-diagnosis. In the same study, it was emphasized that in various studies that it is difficult to differentiate LSIL and HSIL with colposcopic cervical biopsy, and therefore pathologists use immune-histochemical staining for cases in-between [25,26].…”

Section: Discussionmentioning

confidence: 94%

“…In studies evaluating the presence of HSIL, there is evidence of low concordance between colposcopic cervical biopsy and LEEP results [13,14]. A prospective study shows that colposcopic biopsy results report lower rates of HSIL than LEEP [24]. In the study of Kim and et al [24], in terms of HPV detection, 67.7% concordance was found between colposcopic biopsy and LEEP results and 26.6% of the colposcopic biopsy results was under-diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results

Keskın¹,

Bıyık²,

İnce³

et al. 2021

Ginekol Pol

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results

Keskın¹,

Bıyık²,

İnce³

et al. 2021

Ginekol Pol

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show abstract

“…The diagnostic discrepancy between CDB&ECC and conization has been reported in previous studies, reporting an underdiagnosis rate ranging from 6.4% to 23.1%. 7,[12][13][14][15][16][17][18][19] The diagnostic agreement between CDB&ECC and conization was 43-85.8% according to those studies, and our study reported a relatively high concordance rate, 72.4%. As the last step of the "threestep" screening procedure, CDB&ECC is the most convincing procedure before diagnostic conization.…”

Section: Discussionsupporting

confidence: 56%

“…Some underdiagnosed lesions were further diagnosed as invasive cancer by conization, which were occult and easy to miss. 6,7 Diagnostic cervical conization requires omnidirectional cervical sampling, which can greatly improve the early diagnostic rate of early-stage invasive cervical cancer and identify occult cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Li¹,

Gong²,

Wang³

et al. 2021

IJWH

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Early-stage cervical cancer is usually diagnosed by colposcopy-directed biopsy (CDB) and/or endocervical curettage (ECC), but some neglected lesions must be detected by conization because they are occult. This study aimed to explore the optimal method for detecting these "occult" cervical cancers. Patients and Methods: A total of 1299 patients who were high-risk for early-stage cervical cancer from five centres in China were prospectively included. We evaluated the diagnostic performance of cytology, HPV testing, colposcopy and CDB&ECC for detecting "occult" cervical cancer and discussed the diagnostic importance of transformation zone (TZ) type, conization length and the proportion of cervical cone excision. Results:The diagnostic agreement between colposcopy impression and conization was 64.5% and 72.4% between CDB&ECC and conization. Forty-two patients were finally diagnosed with pathologic cancer, and the sensitivities of cytology, colposcopy, CDB&ECC were 4.8%, 7.1%, and 47.4%, respectively. Twenty cases were neglected by CDB&ECC but further diagnosed as cancer by conization, considered to be occult cervical cancer, accounting for 1.6%. Cytologic high-grade squamous intraepithelial lesion (HSIL)+, positive HPV, biopsy HSIL+ and cervical TZ type 3 were considered risk factors for developing HSIL+, while colposcopy impression HSIL+ was not. There was a significant difference between cancerous and HSIL patients in the proportion of cervical cone excision (P<0.001), which was recognized as a risk factor (P<0.001) for detecting cancer, while the length of cervical cone excision was not. The average proportion was 0.62, and the minimal effective proportion was 0.56. Conclusion: Since the incidence of occult cervical cancer neglected by CDB&ECC, colposcopy and cytology was far beyond expectations, conization is necessary, especially in patients with TZ type 3, high-grade cytology and biopsy results. As the cervical length varies in patients, the proportion of cervical cone excision might be a better indicator for detecting occult cervical cancer.

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Risk‐stratified management of cervical high‐grade squamous intraepithelial lesion based on machine learning

Zhang,

Tian,

et al. 2024

Journal of Medical Virology

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The concordance rate between conization and colposcopy‐directed biopsy (CDB) proven cervical high‐grade squamous intraepithelial lesion (HSIL) were 64−85%. We aimed to identify the risk factors associated with pathological upgrading or downgrading after conization in patients with cervical HSIL and to provide risk‐stratified management based on a machine learning predictive model.This retrospective study included patients who visited the Obstetrics and Gynecology Hospital of Fudan University from January 1 to December 31, 2019, were diagnosed with cervical HSIL by CDB, and subsequently underwent conization. A wide variety of data were collected from the medical records, including demographic data, laboratory findings, colposcopy descriptions, and pathological results. The patients were categorized into three groups according to their postconization pathological results: low‐grade squamous intraepithelial lesion (LSIL) or below (downgrading group), HSIL (HSIL group), and cervical cancer (upgrading group). Univariate and multivariate analyses were performed to identify the independent risk factors for pathological changes in patients with cervical HSIL. Machine learning prediction models were established, evaluated, and subsequently verified using external testing data.In total, 1585 patients were included, of whom 65 (4.1%) were upgraded to cervical cancer after conization, 1147 (72.4%) remained having HSIL, and 373 (23.5%) were downgraded to LSIL or below. Multivariate analysis showed a 2% decrease in the incidence of pathological downgrade for each additional year of age and a 1% increase in lesion size. Patients with cytology > LSIL (odds ratio [OR] = 0.33; 95% confidence interval [CI], 0.21–0.52), human papillomavirus (HPV) infection (OR = 0.33; 95% CI, 0.14–0.81), HPV 33 infection (OR = 0.37; 95% CI, 0.18–0.78), coarse punctate vessels on colposcopy examination (OR = 0.14; 95% CI, 0.06–0.32), HSIL lesions in the endocervical canal (OR = 0.48; 95% CI, 0.30–0.76), and HSIL impression (OR = 0.02; 95% CI, 0.01–0.03) were less likely to experience pathological downgrading after conization than their counterparts. The independent risk factors for pathological upgrading to cervical cancer after conization included the following: age (OR = 1.08; 95% CI, 1.04–1.12), HPV 16 infection (OR = 4.07; 95% CI, 1.70–9.78), the presence of coarse punctate vessels during colposcopy examination (OR = 2.21; 95% CI, 1.08–4.50), atypical vessels (OR = 6.87; 95% CI, 2.81–16.83), and HSIL lesions in the endocervical canal (OR = 2.91; 95% CI, 1.46–5.77). Among the six machine learning prediction models, the back propagation (BP) neural network model demonstrated the highest and most uniform predictive performance in the downgrading, HSIL, and upgrading groups, with areas under the curve (AUCs) of 0.90, 0.84, and 0.69; sensitivities of 0.74, 0.84, and 0.42; specificities of 0.90, 0.71, and 0.95; and accuracies of 0.74, 0.84, and 0.95, respectively. In the external testing set, the BP neural network model showed a higher predictive performance than the logistic regression model, with an overall AUC of 0.91. Therefore, a web‐based prediction tool was developed in this study.BP neural network prediction model has excellent predictive performance and can be used for the risk stratification of patients with CDB‐diagnosed HSIL.

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Pathologic discrepancies between colposcopy-directed biopsy and loop electrosurgical excision procedure of the uterine cervix in women with cytologic high-grade squamous intraepithelial lesions

Cited by 23 publications

References 30 publications

Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results

Evaluation of the consistency ratios of cervical smear, cervical biopsy and conization results

Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Risk‐stratified management of cervical high‐grade squamous intraepithelial lesion based on machine learning

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