Could We Reduce Unnecessary Colposcopic Examinations?

  • Banuhan Şahin Amasya University, Medical School, Sabuncuoglu Serefeddin Research and Training Hospital, Department of Gynecology and Obstetrics, Amasya
  • Pervin Karlı Amasya University, Medical School, Sabuncuoglu Serefeddin Research and Training Hospital, Department of Gynecology and Obstetrics, Amasya
  • Osman Fadıl Kara Amasya University, Medical School, Sabuncuoglu Serefeddin Research and Training Hospital, Department of Gynecology and Obstetrics, Amasya

Abstract

Objective: We assessed outcomes of biopsies due to colposcopic examination because of abnormal pap smear or positive HPV test and we reviewed our approach to cervical intraepithelial lesions in the light of the literature. Methods: This was a retrospective study involving 115 women who underwent colposcopy with positive HPV test or abnormal pap smear results in Amasya University gynecology policlinic from January 2017 to June 2018. Demographic data, colposcopy indications, HPV genotypes, cytology and biopsy results were assessed. All data were calculated with SPSS (Version 22.0, SPSS Inc., Chicago, IL, USA) for statistical analysis. Relationships between categorical variables were assessed by Fisher's Chi-square test (Fisher's Exact test). Statistical significance was accepted as p <0.05.  Results: The median age of the colposcopy performed population was 45 (30-65 years). The rates of high risk HPV genotypes 16, 18, 16/18 and non-16/18-HPV were found to be 28.7%, 15.6%, 10.4% and 48.7%, respectively. The rates of pap-smear cytology; ASC-US, LG-SIL and HG-SIL were found to be 30.4%, 9.6% and 6.1%, respectively. The rates of colposcopic biopsy results LG-SIL and HG-SIL were found to be 20% and 9.6%. There was no relationship between the groups of HPV genotypes and pap-smear results (p>0.05). HG-SIL histopathology was frequently detected with HPV-16 genotypes. When the number of punch biopsies increased, high-grade lesions were identified greatly (p=0.01). Conclusion: The number of unnecessary colposcopic examinations and colposcopy induced biopsies could be reduced without fear of kidnapping the diagnosis of cervical cancer.

References

References

Dogan O, Yildiz A, Pulatoglu C. Management of abnormal cytology results and correlation of cytopathologic results accompanied by colposcopy in our clinic. Clin Exp Med 2017; 2(3): 62-5.

Saslow D, Solomon D, Lawson HW, Killackey M, Kulasingam SL, Cain J. American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology screening guidelines for the prevention and early detection of cervical cancer. CA: a cancer journal for clinicians 2012; 62(3), 147-72.

Turkish Cervical Cancer and Cervical Cytology Research Group. Prevalence of cervical cytological abnormalities in Turkey. International Journal of Gynecology & Obstetrics 2009; 106(3), 206-9.

Gultekin M, Zayifoglu Karaca M, Kucukyildiz I, Dundar S, Boztas G, Semra Turan H. Initial results of population based cervical cancer screening program using HPV testing in one million Turkish women. International journal of cancer 2018; 142(9), 1952-8.

Petry KU, Cox JT, Johnson K, Quint W, Ridder R, Sideri M, Behrens CM. Evaluating HPV‐negative CIN2+ in the ATHENA trial. International journal of cancer 2016; 138(12), 2932-9.

Arbyn M, Ronco G, Anttila A, Meijer CJ, Poljak M, Ogilvie G, Peto J. Evidence regarding human papillomavirus testing in secondary prevention of cervical cancer. Vaccine 2012; 30, 88-99.

Massad LS, Einstein MH, Huh WK, Katki HA, Kinney WK, Schiffman M, Lawson HW. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Obstetrics & Gynecology 2013; 121(4), 829-46.

Wentzensen N, Massad LS, Mayeaux Jr EJ, Khan MJ, Waxman AG, Einstein MH, Chelmow D. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. Journal of lower genital tract disease 2017; 21(4), 216-22.

Hu SY, Zhang WH, Li SM, Li N, Huang MN, Pan QJ, Qiao YL. Pooled analysis on the necessity of random 4-quadrant cervical biopsies and endocervical curettage in women with positive screening but negative colposcopy. Medicine 2017; 96(17).

Chen Q, Du H, Pretorius RG, Wang C, Yang B, Wang G, Wu R. High-grade cervical intraepithelial neoplasia detected by colposcopy-directed or random biopsy relative to age, cytology, human papillomavirus 16, and lesion size. Journal of lower genital tract disease 2016; 20(3), 207-12.

Underwood M, Arbyn M, Parry‐Smith W, De Bellis‐Ayres S, Todd R, Redman CWE, Moss EL. Accuracy of colposcopy‐directed punch biopsies: a systematic review and meta‐analysis. BJOG: An International Journal of Obstetrics & Gynaecology 2012; 119(11), 1293-301.

Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, Wilkinson EJ. The lower anogenital squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Archives of pathology & laboratory medicine 2012; 136(10), 1266-97.

Wentzensen N, Schiffman M, Silver MI, Khan MJ, Perkins RB, Smith KM, Mayeaux Jr EJ. ASCCP colposcopy standards: risk-based colposcopy practice. Journal of lower genital tract disease 2017; 21(4), 230-4.

Wentzensen N, Walker JL, Gold MA, Smith KM, Zuna RE, Mathews C, Tenney M. Multiple biopsies and detection of cervical cancer precursors at colposcopy. Journal of Clinical Oncology 2015; 33(1), 83.

Moss EL, Hadden P, Douce G, Jones PW, Arbyn M, Redman CW. Is the colposcopically directed punch biopsy a reliable diagnostic test in women with minor cytological lesions?. Journal of lower genital tract disease 2012; 16(4), 421-6.

Fan A, Zhang L, Wang C, Wang Y, Han C, Xue F. Analysis of clinical factors correlated with the accuracy of colposcopically directed biopsy. Archives of gynecology and obstetrics 2017; 296(5), 965-72.

Pretorius RG, Zhang WH, Belinson JL, Huang MN, Wu LY, Zhang X, Qiao YL. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. American journal of obstetrics and gynecology 2004; 191(2), 430-4.

Huh WK, Sideri M, Stoler M, Zhang G, Feldman R, Behrens CM. Relevance of random biopsy at the transformation zone when colposcopy is negative. Obstetrics & Gynecology 2014; 124(4), 670-8.

Published
2020-06-11
Section
Original Research