The accuracy of diagnosing cervical intraepithelial neoplasia with colposcopically directed biopsy

Abstract

To evaluate the accuracy of colposcopically directed biopsy in the diagnosis of cervical intraepithelial neoplasia (CIN). The clinical data of 153 patients with CIN diagnosed by colposcopically directed biopsy and treated with cervical loop electrosurgical procedure (LEEP) shortly after were retrospectively studied. The consistency of pathological examination between colposcopically directed biopsy and LEEP was evaluated. The factors of missed diagnosis of cervical invasive carcinoma were analyzed. The diagnosis of 106 out of the 153 patients by colposcopically directed biopsy was consistent with that by LEEP as confirmed by pathologic diagnosis with a consistence rate of 69.3%, however, the diagnoses of 47 of the 153 patients by colposcopically directed biopsy were not consistent with those by LEEP, with an inconsistent rate of 30.7%, including 22 cases of overdiagnosis (14.4%, 22/153) and 25 cases of underdiagnosis (16.3%, 25/153). Eighteen patients were confirmed as with cervical invasive carcinoma by LEEP/hysterectomy at last with a missed diagnosis rate of 11.8%. The missed diagnosis rate of invasive carcinoma by colposcopically directed biopsy was significantly higher in the patients with cytologic diagnosis of with > or = HSIL than in the patients cytologically diagnosed as with < HSIL (chi(2) = 8.208, P < 0.05). The accuracy of diagnosing CIN with colposcopically directed biopsy is still unsatisfying. Attention should be paid on the patients with cytological diagnosis of > or = HSIL so as to avoid missed diagnosis of cervical carcinoma.