Analysis of the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy in a single tertiary center of Chengdu

Juan Li; Wei Wang; Ping Yang; Jing Chen; Qianling Dai; Ping Hua; Dandan Liu

doi:10.1007/s00404-021-06012-y

Analysis of the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy in a single tertiary center of Chengdu

Arch Gynecol Obstet. 2021 Oct;304(4):1033-1041. doi: 10.1007/s00404-021-06012-y. Epub 2021 Mar 8.

Authors

Juan Li¹, Wei Wang², Ping Yang³, Jing Chen¹, Qianling Dai¹, Ping Hua⁴, Dandan Liu¹

Affiliations

¹ Department of Diagnosis and Treatment for Vulval and Cervical Diseases, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China.
² Department of Diagnosis and Treatment for Vulval and Cervical Diseases, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China. 592213263@qq.com.
³ Chengdu Branch of the China Electronics Technology Group Corporation, Big Data Research Institute Co., Ltd. Chengdu, Sichuan, 610000, China.
⁴ Department of Pathology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan, China.

PMID: 33683424
DOI: 10.1007/s00404-021-06012-y

Abstract

Purpose: The aim of this retrospective study was to analyze the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy.

Methods: The medical records of patients underwent a colposcopy-guided cervical biopsy at Chengdu Women's and Children's Central Hospital between January 2017 and January 2019 were collected, including age, menopausal status, cervical cytology and human papillomavirus (HPV) test results, type of transformation zone, colposcopic diagnosis and histopathological outcomes of cervical biopsy. Colposcopy was carried out using 2011 colposcopic terminology of International Federation for Cervical Pathology and Colposcopy (IFCPC). Related variables were analyzed.

Results: A total of 495 patients were collected in this study. The perfect agreement between colposcopic impression and histopathological diagnosis was 46.9%, and the strength of agreement with kappa value was 0.283 (P < 0.001), and the agreement within 1 grade was 93.5%. Positive predictive value (PPV), negative predictive value (NPV), sensitivity, specificity, false-positive rate and false-negative rate of detecting HSIL or more (HSIL +) were 93.1%, 57.8%, 80.9%, 93.9%, 6.1% and 45.3%, respectively. Colposcopic diagnosis more often underestimated (43.2%) [especially in HSIL (59.3%) and carcinoma (70.7%) patients] than overestimated (9.9%) in cervical lesions. The results of cytology, HPV status, patients' age and different experiences of practitioners were the factors for under-diagnosis of HSIL + by colposcopy.

Conclusion: Colposcopy is an excellent tool to estimate cervical high-grade lesion but is imprecise. Many factors can bias the diagnosis of colposcopy, especially the known results of cervical cytology and HPV. Precise diagnosis of cervical lesion should rely on the colposcopy-directed biopsy.

Keywords: Agreement; Cervical cancer; Colposcopic diagnosis; Colposcopy-directed biopsy; High-grade squamous intraepithelial lesions (HSIL).

MeSH terms

Biopsy
Child
Colposcopy
Female
Humans
Pregnancy
Retrospective Studies
Uterine Cervical Neoplasms* / diagnosis