Abstract
BackgroundInappropriate 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.MethodsRecords 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.ResultsData 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.ConclusionEvidence 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.
Highlights
Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis
Of the 1130 patients included in this study, 69.64% (n = 787) received a consistent diagnosis, whereas 30.35% (n = 343) of all HSIL+ patients were not identified through colposcopy
73.7% of all HSIL cases were detected through colposcopy
Summary
Inappropriate management of high-grade squamous intraepithelial lesions (HSIL) may be the result of an inaccurate colposcopic diagnosis. In 2020, cervical cancer caused approximately 340,000 deaths with a further 600,000 new cases recorded. Human papillomavirus (HPV) infection is universally recognized as a causative agent in the development of cervical intraepithelial neoplasia (CIN) and squamous intraepithelial lesions. These can be benign but are considered pre-cancerous and often develop into invasive cervical carcinoma [4]. As precursors to invasive squamous carcinoma, over one third of all high-grade squamous intraepithelial lesions (HSIL) and CIN grades II and III, progress into cervical cancer over a period of between 10 and 15 years [5]
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