Pathologic discrepancies between colposcopy-directed biopsy and loop electrosurgical excision procedure of the uterine cervix in women with cytologic high-grade squamous intraepithelial lesions
- Author:
Se Ik KIM
1
;
Se Jeong KIM
;
Dong Hoon SUH
;
Kidong KIM
;
Jae Hong NO
;
Yong Beom KIM
Author Information
- Publication Type:Original Article
- Keywords: Papanicolaou Test; Colposcopy; Conization; High-Grade Squamous Intraepithelial Lesions; Uterine Cervical Neoplasms; Early Detection of Cancer
- MeSH: Adenocarcinoma in Situ; Biopsy; Cervical Intraepithelial Neoplasia; Cervix Uteri; Colposcopy; Conization; Dataset; Diagnosis; Early Detection of Cancer; Female; Humans; Papanicolaou Test; Retrospective Studies; Sensitivity and Specificity; Squamous Intraepithelial Lesions of the Cervix; Uterine Cervical Neoplasms
- From:Journal of Gynecologic Oncology 2020;31(2):13-
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: To investigate pathologic discrepancies between colposcopy-directed biopsy (CDB) of the cervix and loop electrosurgical excision procedure (LEEP) in women with cytologic high-grade squamous intraepithelial lesions (HSILs).METHODS: We retrospectively identified 297 patients who underwent both CDB and LEEP for HSILs in cervical cytology between 2015 and 2018, and compared their pathologic results. Considering the LEEP to be the gold standard, we evaluated the diagnostic performance of CDB for identifying cervical intraepithelial neoplasia (CIN) grades 2 and 3, adenocarcinoma in situ, and cancer (HSIL+). We also performed age subgroup analyses.RESULTS: Among the study population, 90.9% (270/297) had pathologic HSIL+ using the LEEP. The diagnostic performance of CDB for identifying HSIL+ was as follows: sensitivity, 87.8%; specificity, 59.3%; balanced accuracy, 73.6%; positive predictive value, 95.6%; and negative predictive value, 32.7%. Thirty-three false negative cases of CDB included CIN2,3 (n=29) and cervical cancer (n=4). The pathologic HSIL+ rate in patients with HSIL− by CDB was 67.3% (33/49). CDB exhibited a significant difference in the diagnosis of HSIL+ compared to LEEP in all patients (p<0.001). In age subgroup analyses, age groups <35 years and 35–50 years showed good agreement with the entire data set (p=0.496 and p=0.406, respectively), while age group ≥50 years did not (p=0.036).CONCLUSION: A significant pathologic discrepancy was observed between CDB and LEEP results in women with cytologic HSILs. The diagnostic inaccuracy of CDB increased in those ≥50 years of age.
