PDF herunterladen
CC BY-NC-ND 4.0 · Rev Bras Ginecol Obstet 2018; 40(07): 410-416
DOI: 10.1055/s-0038-1666995
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Performance of Conventional Cytology and Colposcopy for the Diagnosis of Cervical Squamous and Glandular Neoplasias

Desempenho da citologia convencional e da colposcopia para o diagnóstico de neoplasias cervicais escamosas e glandulares
Giselle Fachetti-Machado
1   Health Sciences Postgraduate Program, Universidade Federal de Goiás, Goiânia, GO, Brazil
,
Rosane Ribeiro Figueiredo-Alves
1   Health Sciences Postgraduate Program, Universidade Federal de Goiás, Goiânia, GO, Brazil
,
Marise Amaral Rebouças Moreira
1   Health Sciences Postgraduate Program, Universidade Federal de Goiás, Goiânia, GO, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

03. Februar 2018

17. Mai 2018

Publikationsdatum:
11. Juli 2018 (online)

   Lizenzen und Reprints

Abstract

Objective To estimate the cytological and colposcopic performances for the diagnosis of cervical neoplasias.

Methods Cross-sectional retrospective study with data from patients' charts. The participants underwent colposcopy, guided biopsies, and excision when needed. The cytological and colposcopic categorization followed the Bethesda System and the international colposcopic terminologies. The cytology and colposcopy performances were evaluated by sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) analyses with 95% confidence interval (95% CI).

Results From 1,571 participants, a total of 1,154 (73.4%) were diagnosed with cervical squamous intraepithelial neoplasia grade 2 or worse (CIN 2+), 114 (7.2%) with adenocarcinoma in situ or worse (AIS+), 615 (39.2%) presented atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion or worse (ASC-H+) cytology, and 934 (59.4%) presented major or suspicious for invasion colposcopic abnormalities. The SE, SP, PPV, and NPV of ASC-H+ for diagnoses of CIN 2+ and AIS+ were, respectively: 44% (95% CI: 41–47) and 72% (95% CI: 67–76), 79% (95% CI: 77–81) and 79% (95% CI: 75–83), 88% (95% CI: 87–90) and 55% (95% CI: 50–60), and 28% (95% CI: 26–31) and 88% (95% CI: 85–91). The SE, SP, PPV, and NPV of major or suspicious for invasion colposcopic abnormalities for diagnoses of CIN 2+ and AIS+ were, respectively: 62% (95% CI: 60–65) and 86% (95% CI: 83–89), 59% (95% CI: 57–62) and 59% (95% CI: 55–64), 85% (95% CI: 83–87) and 44% (95% CI: 40–49), and 29% (95% CI: 27–32) and 92% (95% CI: 89–94).

Conclusion The SE analyses results of ASC-H+ and major or suspicious for invasion colposcopic abnormalities were higher for diagnoses of glandular neoplasias. These results confirm the role of cytology in identifying women at risk who will have their final diagnoses settled by colposcopy and histology.

Resumo

Objetivo Estimar o desempenho da citologia e colposcopia no diagnóstico das neoplasias cervicais.

Métodos Estudo retrospectivo de corte transversal com dados coletados em prontuários. Foram incluídas participantes que foram submetidas a colposcopia, biópsia e excisão quando necessário. A categorização da citologia e da colposcopia seguiram a terminologia de Bethesda e a classificação colposcópica internacional. Os desempenhos da citologia e colposcopia foram avaliados por análises de sensibilidade (S), especificidade (E), valor preditivo positivo (VPP) e valor preditivo negativo (VPN), com intervalos de confiança de 95% (IC 95%).

Resultados Das 1.571 participantes, um total de 1.154 (73,4%) foram diagnosticadas com neoplasia intraepitelial escamosa cervical de grau 2 ou mais grave (NIC 2+), 114 (7,2%) com adenocarcinoma in situ ou mais grave (AIS+), 615 (39,2%) apresentaram células escamosas atípicas de significado indeterminado, quando não se pode excluir lesão intraepitelial de alto grau ou mais grave (ASC-H+) e 934 (59,4%) tiveram achados colposcópicos maiores ou suspeitos de invasão. Os valores de S, E, VPP e VPN das ASC-H+ para o diagnóstico de NIC 2+ e AIS+ foram, respectivamente: 44% (IC 95%: 41–47) e 72% (IC 95%: 67–76), 79% (IC 95%: 77–81) e 79% (IC 95%: 75–83), 88% (IC 95%: 87–90) e 55% (IC 95%: 50–60) e 28% (IC 95%: 26–31) e 88% (IC 95%: 85–91). Os valores de S, E, VPP e VPN dos achados colposcópicos maiores ou suspeitos de invasão para o diagnóstico de NIC 2+ e AIS+ foram, respectivamente: 62% (IC 95%: 60–65) e 86% (IC 95%: 83–89), 59% (IC 95%: 57–62) e 59% (IC 95%: 55–64), 85% (IC 95%: 83–87) e 44% (IC 95%: 40–49) e 29% (IC 95%: 27–32) e 92% (IC 95%: 89–94).

Conclusão Os resultados das análises de S de ASC-H+ e achados colposcópicos maiores ou suspeitos de invasão foram mais elevados para o diagnóstico das neoplasias glandulares. Esses resultados confirmam o papel da citologia na identificação de mulheres em risco que terão seus diagnósticos definidos por colposcopia e histologia.

Keywords

uterine cervical neoplasms - cervical intraepithelial neoplasia - squamous intraepithelial lesions of the cervix - adenocarcinoma in situ - papanicolaou test - colposcopy - sensitivity and specificity

Palavras-chave

neoplasias do colo do útero - neoplasia intraepitelial cervical - lesões intraepiteliais escamosas cervicais - adenocarcinoma in situ - exame colpocitológico - colposcopia - sensibilidade e especificidade

Contributions

Fachetti-Machado G., Figueiredo-Alves R. R. and Moreira M. A. R. contributed with the project and interpretation of data, writing of the article, critical review of the intellectual content and final approval of the version to be published.


 

  • References

  • 1 Koss LG. The Papanicolaou test for cervical cancer detection. A triumph and a tragedy. JAMA 1989; 261 (05) 737-743 . Doi:10.1001/jama.1989.03420050087046
    CrossrefPubMedGoogle Scholar
  • 2 Chan PG, Sung HY, Sawaya GF. Changes in cervical cancer incidence after three decades of screening US women less than 30 years old. Obstet Gynecol 2003; 102 (04) 765-773 . Doi:10.1016/S0029-7844(03)00696-3
    PubMedGoogle Scholar
  • 3 Massad LS, Jeronimo J, Katki HA, Schiffman M. ; National Institutes of Health/American Society for Colposcopy and Cervical Pathology Research Group. The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia. J Low Genit Tract Dis 2009; 13 (03) 137-144 . Doi:10.1097/LGT.0b013e31819308d4
    CrossrefPubMedGoogle Scholar
  • 4 Jordan J, Arbyn M, Martin-Hirsch P. , et al. European guidelines for quality assurance in cervical cancer screening: recommendations for clinical management of abnormal cervical cytology, part 1. Cytopathology 2008; 19 (06) 342-354 . Doi:10.1111/j.1365-2303.2008.00623.x
    CrossrefPubMedGoogle Scholar
  • 5 Drolet M, Bénard É, Boily MC. , et al. Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis. Lancet Infect Dis 2015; 15 (05) 565-580 . Doi:10.1016/S1473-3099(14)71073-4
    CrossrefPubMedGoogle Scholar
  • 6 Jeronimo J, Schiffman M. Colposcopy at a crossroads. Am J Obstet Gynecol 2006; 195 (02) 349-353 . Doi:10.1016/j.ajog.2006.01.091
    CrossrefPubMedGoogle Scholar
  • 7 Nayar R, Wilbur DC. The Pap Test and Bethesda 2014. “The reports of my demise have been greatly exaggerated.” (after a quotation from Mark Twain). Acta Cytol 2015; 59 (02) 121-132 . Doi:10.1159/000381842
    CrossrefPubMedGoogle Scholar
  • 8 Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância. Divisão de Detecção Precoce e Apoio à Organização de Rede. Diretrizes Brasileiras para o Rastreamento do Câncer do Colo do Útero. 2a ed. Rio de Janeiro, RJ: INCA; 2016. http://www1.inca.gov.br/inca/Arquivos/DDiretrizes_para_o_Rastreamento_do_cancer_do_colo_do_utero_2016_corrigido.pdf . Acessed March 26, 2018
    PubMedGoogle Scholar
  • 9 Bornstein J, Bentley J, Bösze P. , et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 2012; 120 (01) 166-172 . Doi:10.1097/AOG.0b013e318254f90c
    CrossrefPubMedGoogle Scholar
  • 10 Wright VC, Dubuc-Lissoir J, Ehlen T, Heywood M, Plante M. Guidelines on adenocarcinoma in situ of the cervix: clinical features and review of management. J Obstet Gynaecol Can 1999; 21 (07) 699-706 . Doi:10.1016/S0849-5831(16)30106-9
    PubMedGoogle Scholar
  • 11 Scully RE, Bonfiglio TA, Kurman RJ, Silverberg SG, Wilkinson EJ. Histological Typing of Female Genital Tract Tumors. 2nd ed. Berlin: Spring Verlag; 1994
    CrossrefGoogle Scholar
  • 12 Buckley CH, Butler EB, Fox H. Cervical intraepithelial neoplasia. J Clin Pathol 1982; 35 (01) 1-13 . Doi:10.1136/jcp.35.1.1
    CrossrefPubMedGoogle Scholar
  • 13 Bonita R, Beaglehole R, Kjellström T. Epidemiologia Básica. 2a ed. São Paulo, SP: Santos; 2010
    Google Scholar
  • 14 Kietpeerakool C, Srisomboon J, Prompittayarat W, Kanjanavaha P, Peuwsai R, Dheerakul C. Can adenocarcinoma in situ of the uterine cervix be predicted before cervical conization?. Asian Pac J Cancer Prev 2006; 7 (04) 522-524
    PubMedGoogle Scholar
  • 15 Miller RA, Mody DR, Tams KC, Thrall MJ. Glandular lesions of the cervix in clinical practice: a cytology, histology, and human papillomavirus correlation study from 2 institutions. Arch Pathol Lab Med 2015; 139 (11) 1431-1436 . Doi:10.5858/arpa.2014-0633-OA
    CrossrefPubMedGoogle Scholar
  • 16 Patil PR, Jibhkate SN. Cytohistopathological correlation of Papanicolaou smears: a hospital based study. Int J Reprod Contracept Obstet Gynecol 2016; 5: 1695-1699 . Doi:10.18203/2320-1770.ijrcog20161424
    CrossrefPubMedGoogle Scholar
  • 17 Naik R, Minj AM, Panda R, Satpathi S, Behera PK, Panda KM. Cytohistological correlation and accuracy of the Pap smear test in diagnosis of cervical lesions: a hospital based cross-sectional study from Odisha, India. Med Sci 2015; 3: 242-249 . Doi:10.29387/ms.2015.3.3.242-249
    CrossrefPubMedGoogle Scholar
  • 18 Alves RRF, Teixeira TS, Netto JCA. Performance da citologia e colposcopia frente à histopatologia no rastreamento e diagnóstico das lesões precursoras do câncer do colo uterino. DST J Bras Doenças Sex Transm. 2002; 14: 33-38
    PubMedGoogle Scholar
  • 19 Sankaranarayanan R, Thara S, Sharma A. , et al; Multicentre Study Group on Cervical Cancer Early Detection in India. Accuracy of conventional cytology: results from a multicentre screening study in India. J Med Screen 2004; 11 (02) 77-84 . Doi:10.1258/096914104774061056
    CrossrefPubMedGoogle Scholar
  • 20 Wu Q, Zhao X, Fu Y. , et al. A cross-sectional study on HPV testing with type 16/18 genotyping for cervical cancer screening in 11,064 Chinese women. Cancer Med 2017; 6 (05) 1091-1101 . Doi:10.1002/cam4.1060
    CrossrefPubMedGoogle Scholar
  • 21 Bigras G, de Marval F. The probability for a Pap test to be abnormal is directly proportional to HPV viral load: results from a Swiss study comparing HPV testing and liquid-based cytology to detect cervical cancer precursors in 13,842 women. Br J Cancer 2005; 93 (05) 575-581 . Doi:10.1038/sj.bjc.6602728
    CrossrefPubMedGoogle Scholar
  • 22 Cárdenas-Turanzas M, Nogueras-Gonzalez GM, Scheurer ME. , et al. The performance of human papillomavirus high-risk DNA testing in the screening and diagnostic settings. Cancer Epidemiol Biomarkers Prev 2008; 17 (10) 2865-2871 . Doi:10.1158/1055-9965.EPI-08-0137
    CrossrefPubMedGoogle Scholar
  • 23 Yeoh GP, Chan KW. The accuracy of Papanicolaou smear predictions: cytohistological correlation of 283 cases. Hong Kong Med J 1997; 3 (04) 373-376
    PubMedGoogle Scholar
  • 24 Coste J, Cochand-Priollet B, de Cremoux P. , et al; French Society of Clinical Cytology Study Group. Cross sectional study of conventional cervical smear, monolayer cytology, and human papillomavirus DNA testing for cervical cancer screening. BMJ 2003; 326 (7392): 733 . Doi:10.1136/bmj.326.7392.733
    CrossrefPubMedGoogle Scholar
  • 25 Mayrand MH, Duarte-Franco E, Rodrigues I. , et al; Canadian Cervical Cancer Screening Trial Study Group. Human papillomavirus DNA versus Papanicolaou screening tests for cervical cancer. N Engl J Med 2007; 357 (16) 1579-1588 . Doi:10.1056/NEJMoa071430
    CrossrefPubMedGoogle Scholar
  • 26 Petry KU, Menton S, Menton M. , et al. Inclusion of HPV testing in routine cervical cancer screening for women above 29 years in Germany: results for 8466 patients. Br J Cancer 2003; 88 (10) 1570-1577 . Doi:10.1038/sj.bjc.6600918
    CrossrefPubMedGoogle Scholar
  • 27 Ronco G, Cuzick J, Pierotti P. , et al. Accuracy of liquid based versus conventional cytology: overall results of new technologies for cervical cancer screening: randomised controlled trial. BMJ 2007; 335 (7609): 28 . Doi:10.1136/bmj.39196.740995.BE
    CrossrefPubMedGoogle Scholar
  • 28 Moy LM, Zhao FH, Li LY. , et al. Human papillomavirus testing and cervical cytology in primary screening for cervical cancer among women in rural China: comparison of sensitivity, specificity, and frequency of referral. Int J Cancer 2010; 127 (03) 646-656 . Doi:10.1002/ijc.25071
    CrossrefPubMedGoogle Scholar
  • 29 Arbyn M, Sankaranarayanan R, Muwonge R. , et al. Pooled analysis of the accuracy of five cervical cancer screening tests assessed in eleven studies in Africa and India. Int J Cancer 2008; 123 (01) 153-160 . Doi:10.1002/ijc.23489
    CrossrefPubMedGoogle Scholar
  • 30 Kim SH, Lee JM, Yun HG. , et al. Overall accuracy of cervical cytology and clinicopathological significance of LSIL cells in ASC-H cytology. Cytopathology 2017; 28 (01) 16-23 . Doi:10.1111/cyt.12351
    CrossrefPubMedGoogle Scholar
  • 31 Underwood M, Arbyn M, Parry-Smith W. , et al. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG 2012; 119 (11) 1293-1301 . Doi:10.1111/j.1471-0528.2012.03444.x
    CrossrefPubMedGoogle Scholar
  • 32 Aue-Aungkul A, Punyawatanasin S, Natprathan A, Srisomboon J, Kietpeerakool C. “See and treat” approach is appropriate in women with high-grade lesions on either cervical cytology or colposcopy. Asian Pac J Cancer Prev 2011; 12 (07) 1723-1726
    PubMedGoogle Scholar
  • 33 Bryson P, Stulberg R, Shepherd L, McLelland K, Jeffrey J. Is electrosurgical loop excision with negative margins sufficient treatment for cervical ACIS?. Gynecol Oncol 2004; 93 (02) 465-468 . Doi:10.1016/j.ygyno.2004.01.028
    CrossrefPubMedGoogle Scholar
  • 34 Jiang Y, Chen C, Li L. Comparison of cold-knife conization versus loop electrosurgical excision for cervical adenocarcinoma in situ (ACIS): a systematic review and meta-analysis. PLoS One 2017; 12 (01) e0170587 . Doi:10.1371/journal.pone.0170587
    CrossrefPubMedGoogle Scholar