Abstract
PurposeTo evaluate prevalence and diagnostic performance of three colposcopic images to diagnose squamous and glandular cervical precursor neoplasias.MethodsCross-sectional study, conducted through analysis of stored digital colposcopic images. To evaluate the diagnostic performance of three images, herein named grouped glands, aceto-white villi, and atypical vessels, for detection of adenocarcinoma in situ (AIS) and cervical squamous intraepithelial neoplasias (CIN) grades 2 and 3, calculations of sensitivity, specificity, accuracy, positive likelihood ratio, receiver operating characteristic (ROC) curve, and area under the curve (AUC) were made, with their respective 95% confidence intervals.ResultsGrouped glands, aceto-white villi, and atypical vessels images had: prevalence of 21.3, 53.8, and 33.8% in patients with AIS, and 16.2, 19.5, and 9.3% in those with CIN 2 and 3; for the diagnosis of AIS, sensitivity of 21.3, 53.8, and 33.8%, specificity of 89.8, 95.2, and 94.9%, accuracy of 76.6, 87.2, and 83.1%, positive likelihood ratio of 2.1, 11.2, and 6.6, and AUC of 0.55, 0.74, and 0.64; for the diagnosis of CIN 2 and 3, sensitivity of 16.2, 19.5, and 9.3%, specificity of 89.8, 95.2, and 94.9%, accuracy of 39.4, 43.4, and 36.3%, positive likelihood ratio of 1.6, 4.1, and 1, 8, and AUC of 0.53, 0.57, and 0.52, respectively.ConclusionPrevalence and accuracy of the three images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias. Sensitivity, specificity, positive likelihood, and AUC of aceto-white villi and atypical vessels images were higher for the diagnosis of glandular than squamous cervical precursor neoplasias.
Highlights
Invasive cervical cancer is the fourth most diagnosed type of cancer in women worldwide, and 90% of these tumors are carcinomas, malignant neoplasms of epithelial origin
It was noteworthy to detect that the three colposcopic images here evaluated were more prevalent among glandular cervical precursor neoplasias than among squamous lesions; the three images showed higher accuracy for the identification of the former than of the latter
In a previous study carried out by our team, which included 1571 participants, the sensitivity of the cytological abnormality ASC-H + and adenocarcinoma in situ (AIS) + to identify cervical squamous intraepithelial neoplasias (CIN) 2 + [44.0% and 72.0%, respectively] was lower than the sensitivity for major or suspicious for invasion colposcopy findings to identify CIN 2 + [62.0% and 86.0%, respectively]
Summary
Invasive cervical cancer is the fourth most diagnosed type of cancer in women worldwide, and 90% of these tumors are carcinomas, malignant neoplasms of epithelial origin. To the decline in the overall incidence of invasive cervical cancer, observed between the 1960s and the 1990s, an increase was detected in the absolute and relative incidences of different adenocarcinoma subtypes. The implementation of primary prevention of invasive cervical carcinomas using vaccination, associated with the progressive adoption of highly sensitive screening systems, implies earlier detection of cervical precursor neoplasias [11]. This scenario requires more efficient colposcopic procedures for the recognition of discrete images. These three patterns of colposcopic images, which resemble the images previously described by Wright [10], were identified in stored digital colposcopic images and studied for their prevalence and diagnostic performance regarding intraepithelial cervical, squamous, or glandular neoplasias
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