scholarly journals Assessing colposcopic accuracy for high‐grade squamous intraepithelial lesion detection: a retrospective, cohort study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Anying Bai ◽  
Jiaxu Wang ◽  
Qing Li ◽  
Samuel Seery ◽  
Peng Xue ◽  
...  
Keyword(s):  
Predictive Value ◽  
Lesion Detection ◽  
High Grade ◽  
Transformation Zone ◽  
Hpv Status ◽  
Forward Stepwise ◽  
Intraepithelial Lesion ◽  
Child Healthcare ◽  
Histopathological Results ◽  
Intraepithelial Lesions

Abstract Background Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. The aim of this study was to assess colposcopic performance in identifying HSIL+ cases and to analyze the associated clinical factors. Methods Records from 1130 patients admitted to Shenzhen Maternal and Child Healthcare Hospital from 12th January, 2018 up until 30th December, 2018 were retrospectively collected, and included demographics, cytological results, HPV status, transformation zone type, number of cervical biopsy sites, colposcopists’ competencies, colposcopic impressions, as well as histopathological results. Colposcopy was carried out using 2011 colposcopic terminology from the International Federation of Cervical Pathology and Colposcopy. Logistic regression modelling was implemented for uni- and multivariate analyses. A forward stepwise approach was adopted in order to identify variables associated with colposcopic accuracy. Histopathologic results were taken as the comparative gold standard. Results Data from 1130 patient records were collated and analyzed. Colposcopy was 69.7% accurate in identifying HSIL+ cases. Positive predictive value, negative predictive value, sensitivity and specificity of detecting HSIL or more (HSIL+) were 35.53%, 64.47%, 42.35% and 77.60%, respectively. Multivariate analysis highlighted the number of biopsies, cytology, and transformation zone type as independent factors. Age and HPV subtype did not appear to statistically correlate with high-grade lesion/carcinoma. Conclusion Evidence presented here suggests that colposcopy is only 69.7% accurate at diagnosing HSIL. Even though not all HSIL will progress into cancer it is considered pre-cancerous and therefore early identification will save lives. The number of biopsies, cytology and transformation zone type appear to be predictors of misdiagnosis and therefore should be considered during clinical consultations and by way of further research.

scholarly journals Human Papilloma Virus Persistence after Cone Excision in Women with Cervical High Grade Squamous Intraepithelial Lesion: A Prospective Study

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Laurențiu Pirtea ◽  
Dorin Grigoraş ◽  
Petru Matusz ◽  
Marilena Pirtea ◽  
Lavinia Moleriu ◽  
...  
Keyword(s):  
Prospective Study ◽  
Pap Smear ◽  
Hpv Infection ◽  
High Grade ◽  
Transformation Zone ◽  
Large Loop ◽  
Persistence Rate ◽  
Intraepithelial Lesion ◽  
A Prospective Study ◽  
Intraepithelial Lesions

Background. Persistent human papillomavirus (HPV) infection is a necessary event in cervical cancer tumorigenesis. Our objectives were to estimate the rate of HPV infection persistence after large loop excision of the transformation zone (LEEP) in patients with high grade squamous intraepithelial lesions (HSIL) and to investigate if HPV persistence is type related.Methods. We conducted a prospective study on 89 patients with HSIL treated with LEEP. DNA HPV was performed before surgery and at 6, 12, and 18 months after LEEP.Results. Four patients were excluded from the study. The HPV persistence in the remaining 85 patients was 32.95% (6 months), 14.12% (12 months), and 10.59% (18 months). Type 16 had the highest persistence rate, 23.5% (6 months), 11.8% (12 months), and 8.2% (18 months). Coinfection was found to be 54.12% before LEEP and 18.8% (6 months), 4.7% (12 months), and 3.5% (18 months) after LEEP. The rate of coinfections including type 16 was 46.83% of all coinfections. Coinfection including type 16 was not correlated with higher persistence rate compared to infection with type 16 only.Conclusions. HPV infection is not completely eradicated by LEEP in patients with HSIL lesion on PAP smear. HPV persistence after LEEP is influenced by HPV type. HPV type 16 has the highest persistence rate.

scholarly journals Closer to a Uniform Language in Colposcopy: Study on the Potential Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology in Clinical Practice

2017 ◽  
Vol 2017 ◽  
pp. 1-10
Author(s):  
Yanyun Li ◽  
Xiaoling Duan ◽  
Long Sui ◽  
Fengying Xu ◽  
Shuifang Xu ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Predictive Value ◽  
Potential Application ◽  
Predictive Accuracy ◽  
International Federation ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Perfect Agreement ◽  
Transformation Zone ◽  
Intraepithelial Lesion

As the newest colposcopic terminology, the 2011 International Federation for Cervical Pathology and Colposcopy (IFCPC) classification provides standardized interpretation of colposcopic findings. In this study, we analyzed the colposcopic accuracy and the significance of individual findings according to the 2011 IFCPC classification in 525 patients, reviewed by 13 trained colposcopists. Results show that colposcopic diagnoses are in 64.95% perfect agreement with cervical pathology, with 63.64% sensitivity and 96.01% specificity for high-grade squamous intraepithelial lesion (HSIL+). And the accuracy is reproducible across different experienced examiners. Many individual findings, especially the two new signs, inner border sign and ridge sign, are proved to have good predictive accuracy, while iodine negativity demonstrates an inferior performance. However, the distribution of three cervical transformation zone (TZ) types is heterogeneous in examiners. A comparison was also made of the findings of another two colposcopists without nomenclature training according to the Reid Colposcopic Index (RCI), modified RCI, and Swede Score. Results show that colposcopic accuracies in them are lower than in those nomenclature trained colposcopists. The 2011 IFCPC nomenclature improves colposcopic accuracy in trained colposcopists, like speaking the same language. However, the reproducibility of TZ and the predictive value of a few signs remain to be discussed.

Interobserver Variability in Subclassification of Squamous Intraepithelial Lesions

1999 ◽  
Vol 123 (11) ◽  
pp. 1079-1084 ◽  
Author(s):  
Sherry L. Woodhouse ◽  
Janet F. Stastny ◽  
Patricia E. Styer ◽  
Mary Kennedy ◽  
Amy H. Praestgaard ◽  
...  
Keyword(s):  
Interlaboratory Comparison ◽  
Interobserver Variability ◽  
High Grade ◽  
Test Results ◽  
Squamous Intraepithelial Lesions ◽  
Papanicolaou Test ◽  
Management Guidelines ◽  
Significant Difference ◽  
Intraepithelial Lesion ◽  
Intraepithelial Lesions

Abstract Objective.—To determine whether, on a national cytology proficiency test, a competent cytologist can consistently distinguish grades of squamous intraepithelial lesions. Design.—Results for low- and high-grade squamous intraepithelial lesion referenced slides from the College of American Pathologists Interlaboratory Comparison Program in Cervicovaginal Cytology for 1996 and 1997 were analyzed including educational, nongraded vs graded validated slides. Results.—The discrepant rate between low- and high- grade lesions ranged from 9.8% to 15% for cytotechnologist, pathologist, laboratory, and all responses. There was a statistically significant difference in performance on graded, validated slides vs educational slides with better performance on validated slides. Conclusion.—This significant interobserver variability in subclassification of squamous lesions should be considered in management guidelines for abnormal Papanicolaou test results and implementation of national cytology proficiency testing.

8. Human papillomavirus mRNA testing for the detection of anal high-grade squamous intraepithelial lesions in HIV-positive men who have sex with men

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 573
Author(s):  
Elena Sendagorta Cudós ◽  
Maria P. Romero Gomez ◽  
Beatriz Hernandez Novoa ◽  
Ander Mayor ◽  
Jose I. Bernardino De La Serna ◽  
...  
Keyword(s):  
Predictive Value ◽  
Screening Program ◽  
University Hospital ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
Cross Sectional ◽  
Hpv Dna ◽  
Hpv E6 ◽  
Anal Cytology ◽  
Intraepithelial Lesions

Background Currently, screening for anal high-grade squamous intraepithelial lesions (HSIL) relies on anal cytology and high-resolution anoscopy (HRA). Since this approach has limited sensitivity and specificity for detecting anal HSIL, there is increasing interest in the role of biomarkers for predicting anal HSIL. The aim of this study is to evaluate the diagnostic accuracy of HPV E6/E7-mRNA expression for the detection of anal HSIL in MSM HIV-infected patients, in comparison to DNA-HR-HPV and anal cytology. Methods: This cross-sectional screening study included 101 MSM followed at the HIV-unit of La Paz University Hospital. Intra-anal swabs from patients participating in a screening program including cytology, HRA and histology were analysed. HR-HPV-DNA detection was performed by means of the CLART HPV2 assay (GENOMICA SAU.). E6/E7-mRNA detection of HR-HPV types 16, 18, 31, 33 and 45 was performed using the NucliSENS-EasyQ assay (BioMérieux, Marcy l’Etoile, France). Results: HR-HPV DNA and HPV E6/E7 mRNA were detected in 82% and 57% of the anal smears, respectively. Anal cytology screening was abnormal in 70.3%. For the detection of HSIL sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 71.7%, 55.6%, 57.9%, and 69.8% for E6/E7-mRNA testing, respectively, compared with 97.9%, 31.5%, 55.4% and 94.4%, respectively, for HR-HPV DNA testing and 83%, 40.7%, 54.9%, 73.3%, respectively, for cytology testing. Conclusions: In comparison with the other tests, the NucliSENS EasyQ HPV assay yielded a lower clinical sensitivity but a higher clinical specificity and PPV for the detection of anal HSIL in MSM HIV-infected patients.

scholarly journals The Significance of Augmented High-Grade Squamous Intraepithelial Lesion Detection on Pap Test Examination: Partial Results from the RODEO Study Team

2013 ◽  
Vol 57 (5) ◽  
pp. 489-494 ◽  
Author(s):  
Cristovam Scapulatempo ◽  
José Humberto T.G. Fregnani ◽  
Natália Campacci ◽  
Júlio Cesar Possati-Resende ◽  
Adhemar Longatto-Filho
Keyword(s):  
Pap Test ◽  
Lesion Detection ◽  
High Grade ◽  
Squamous Intraepithelial Lesion ◽  
Study Team ◽  
Intraepithelial Lesion

scholarly journals Multiple Biopsies and Detection of Cervical Cancer Precursors at Colposcopy

2015 ◽  
Vol 33 (1) ◽  
pp. 83-89 ◽  
Author(s):  
Nicolas Wentzensen ◽  
Joan L. Walker ◽  
Michael A. Gold ◽  
Katie M. Smith ◽  
Rosemary E. Zuna ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Patient Characteristics ◽  
High Grade ◽  
Transformation Zone ◽  
Additional Lesion ◽  
Multiple Biopsies ◽  
Cancer Precursors ◽  
Intraepithelial Lesions

Purpose Women with abnormal cervical cancer screening results are referred to colposcopy and biopsy for diagnosis of cervical cancer precursors (high-grade squamous intraepithelial lesions [HSILs]). Colposcopy with a single biopsy can miss identification of HSILs. No systematic study has quantified the improved detection of HSIL by taking multiple lesion-directed biopsies. Methods The Biopsy Study was an observational study of 690 women referred to colposcopy after abnormal cervical cancer screening results. Up to four directed biopsies were taken from distinct acetowhite lesions and ranked by colposcopic impression. A nondirected biopsy of a normal-appearing area was added if fewer than four directed biopsies were taken. HSIL identified by any biopsy was the reference standard of disease used to evaluate the incremental yield and sensitivity of multiple biopsies. Results In the overall population, sensitivities for detecting HSIL increased from 60.6% (95% CI, 54.8% to 66.6%) from a single biopsy to 85.6% (95% CI, 80.3% to 90.2%) after two biopsies and to 95.6% (95% CI, 91.3% to 99.2%) after three biopsies. A significant increase in sensitivity of multiple biopsies was observed in all subgroups. The highest increase in yield of HSIL was observed for women with a high-grade colposcopic impression, HSIL cytology, and human papillomavirus (HPV) type 16 positivity. Only 2% of all HSILs diagnosed in the participants were detected by biopsies of normal-appearing transformation zone. Conclusion Collection of additional lesion-directed biopsies during colposcopy increased detection of histologic HSIL, regardless of patient characteristics. Taking additional biopsies when multiple lesions are present should become the standard practice of colposcopic biopsy.

scholarly journals The value of p16INK4a immunostaining for high-grade squamous intraepithelial lesions in human papillomavirus–negative patients

2020 ◽  
Author(s):  
Dai Zhang ◽  
Jie Song ◽  
Xiaosong Zhang ◽  
Hui Bi
Keyword(s):  
Human Papillomavirus ◽  
Predictive Value ◽  
Intraepithelial Neoplasia ◽  
Pathological Diagnosis ◽  
High Grade ◽  
Squamous Intraepithelial Lesions ◽  
P16 Ink4a ◽  
Objective Detection ◽  
High Risk Hpv ◽  
Intraepithelial Lesions

Abstract Background : This study aims to evaluate the value of p16 INK4a immunostaining for high-grade squamous intraepithelial lesions in human papillomavirus–negative patients in Beijing, China. Methods: In this study, we evaluated the value of p16 INK4a immunostaining, as well as cytology and colposcopy, for predicting high-grade squamous intraepithelial lesions (HSIL) in human papillomavirus (HPV)-negative patients by comparing the methods with the haematoxylin and eosin (H&E) staining pathological diagnosis of HPV-negative patients. Results: Of 122 patients negative for the high-risk HPV (HR-HPV) subtype, 26 (21.3%) underwent colposcopically directed multiple punch cervical biopsy with a H&E pathological diagnosis of HSIL and above (HSIL+), 11 patients (9.0%) had cervical intraepithelial neoplasia (CIN)2, nine patients (7.4%) had CIN3, and six patients (4.9%) had infiltrating carcinoma. Cytology, colposcopy, and p16 INK4a immunostaining had 52.4%, 38.5%, and 92.3% sensitivity, respectively, and 76.2%, 94.8%, and 99% specificity, respectively. The positive predictive value of cytology, colposcopy, and p16 INK4a immunostaining was 31.4%, 66.7%, and 96%, respectively, and the negative predictive value was 88.5%, 85.1%, and 97.9%, respectively. Compared with H&E staining, the kappa of cytology, colposcopy, and p16 INK4a immunostaining was 0.327, 0.323, and 0.926, respectively. Conclusion: Positive p16 INK4a immunostaining is very strongly consistent with an H&E diagnosis of CIN2+, and it can be used as an objective detection index for HSIL+ diagnosis of HPV-negative patients with CIN2+.

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