Colposcopic accuracy in detection of early cervical neoplasia

Objective:

An important quality feature of the newly implemented certified Dysplasia Units in Germany is a high accuracy of the differential colposcopy. Aim of the following work is to analyze the correlation of colposcopically findings to the final histological result (either by colposcopically guided biopsy or conization).

Material:

In this retrospective study we analyzed clinical data of 3627 women undergoing a colposcopic examination in the Dysplasia Unit of the university hospital Erlangen from 2014 – 2017. Out of these patients 2112 had a histological result. Histological results were classified as normal, LSIL, HSIL or carcinoma. Colposcopic findings were classified according to the RIO-Classification as normal, minor, major and suspicious for cancer. Parameters were correlated to each other and subgroups such as level of experience of the examiner, type of transformation zone and menopausal status were evaluated.

Results:

712 of 905 women colposcopically assessed to have a major lesion had a histologically confirmed HSIL (78,67%). 443 of 758 women respectively LSIL (58,44%) and 45 of 101 women carcinoma (44,55%) and 1279 of 1472 women had a histologically confirmed regular result (N = 148) or no biopsy (N = 1131) (83,05%). 29 (0,79%) women were underdiagnosed by final histology showing cervical cancer having any other colposcopic finding.

Conclusion:

The technique of colposcopy is the gold standard for further examination of suspicious screening results. Only 0,79% of all women were severly underdiagnosed and finally had an unexpected invasive cancer. Accuracy mainly depends on the level of experience, the type of transformation zone and the menopausal status.