Abstract
Objective: This study aimed to compare the diagnostic value of R-way, the 2011 International Federation for Cervical Pathology and Colposcopy (IFCPC), and Reid colposcopy evaluation system for high-grade squamous intraepithelial lesions and cervical cancer (HSIL+). Methods: A total of 987 cases were referred for vaginal microscopic examination, using R-way system, IFCPC and Reid examination, and diagnostic capabilities of the methods for detecting HSIL+ were compared. Results: Using cervical biopsy or conization as the gold standard, in total 170 women (17.2%) had histologically confirmed HSIL+ including 36 women (3.6%) with invasive cervical cancer. The sensitivity for HSIL+ using the three different colposcopy evaluation methods were 74.7% (127/170), 78.2% (133/170) and 62.9% (107/170) for IFCPC, R-way and Reid. Consistency with histopathology was 69.00%, 75.28% and 55.32%, Kappa values were 0.517, 0.599 and 0.310, respectively. Based on HSIL, sensitivity, specificity, PPV and NPV of IFCPC and R-way pair for HSIL+ were better than those of Reid. McNemar test results revealed significant differences between R-way and IFCPC and between Reid and IFCPC for HSIL+ (χ2 = 19.558, χ2 = 17.876, P < 0.001); however, the consistency rate was better for R-way and IFCPC than for Reid and IFCPC (Kappa = 0.826 vs 0.127, agreement rate: 94.6% vs 70.62%). Conclusion: All three evaluation methods can be used for colposcopy diagnosis of HSIL+, and the diagnostic value of IFCPC and R-way is better than Reid. There is good agreement between R-way colposcopy evaluation and histopathology. Considering the characteristics of easy operation, the R-way evaluation system is worthy of popularization and application in primary hospitals.
Highlights
Cervical cancer is the fourth most common cancer in women
Colposcopy was performed by 5 colposcopy specialists using R-way evaluation method, and targeted cervical biopsy was performed on abnormal areas under colposcopy
The evaluation of consistency between the colposcopy diagnosis and histopathology included a total of 987 patients, with an average age of 41.94 ± 12.45 years
Summary
Cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570,000 women were diagnosed with cervical cancer worldwide and about 311,000 women died from the disease [1]. During this period, early screening and diagnosis can be carried out by means of various screening methods. The implementation of screening programmes in developed countries has reduced the mortality rate of cervical cancer by 70%, but the mortality rate of cervical cancer in China is still very high. Current estimates indicate that every year 106,430 women are diagnosed with cervical cancer in China and 47,739 die from the disease [2]
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