Accuracy of Colposcopically Guided Diagnostic Methods for the Detection of Cervical Intraepithelial Neoplasia

Abstract

Introduction: Many factors can affect the accuracy of colposcopically guided biopsy, endocervical curettage (ECC) and differential cytology, all of which are standard, minimally invasive procedures used to detect cervical intraepithelial neoplasia. Method: All conizations carried out between 2007 and 2013 in the gynecological department of Hannover Medical School were retrospectively reviewed. The agreement between colposcopic diagnosis and histology was evaluated retrospectively. The analysis included 593 complete datasets out of a total of 717 cases treated. Results: The overall agreement was 85.5 %; the accuracy was significantly higher (p = 0.029) when three biopsy specimens were taken rather than just one. The agreement between diagnosis and histological findings from conization was highest for women < 30 years (90.7 %) and lowest for women > 50 years (72.1 %; p = 0.008). The agreement between preoperative differential cytology and histology results after conization was 86.7 % and improved as patient age increased (p = 0.035). The agreement between ECC findings and the results of conization was only 49.1 % irrespective of patient age, transformation zone or the patientʼs menopausal status. Conclusion: The accuracy of colposcopically guided biopsy appears to increase when three biopsy specimens are taken and is particularly high for younger patients. Differential cytology was also found to be highly accurate and is particularly useful for patients aged more than 50 years. The accuracy of ECC was significantly lower; however ECC can provide important additional information in selected cases.

Zusammenfassung

Einleitung: Die Abklärungskolposkopie mit Biopsieentnahme, endozervikaler Kürettage (ECC) und Differenzialzytologie als Goldstandard in der minimalinvasiven Diagnostik zervikaler intraepithelialer Neoplasien wird in ihrer Aussagekraft durch verschiedene Faktoren beeinflusst. Methodik: Die Übereinstimmung der kolposkopischen Diagnose mit der endgültigen Histologie wurde retrospektiv anhand aller zwischen 2007 bis 2013 durchgeführten Konisationen in der Frauenklinik der Medizinischen Hochschule Hannover ausgewertet. Von insges. 717 ermittelten Fällen konnten 593 vollständige Datensätze in die Auswertung aufgenommen werden. Ergebnisse: Insgesamt betrug die Übereinstimmung 85,5 % mit signifikant höherer Treffsicherheit (p = 0,029) bei der Entnahme von 3 Biopsien vs. 1 Biopsie. Die Übereinstimmung war am höchsten bei Frauen < 30 Jahren (90,7 %) und am geringsten > 50 Jahren (72,1 %; p = 0,008). Der differenzialzytologische Abstrich ergab eine Übereinstimmung von 86,7 % mit zunehmender Treffsicherheit bei höherem Alter (p = 0,035). Die ECC hatte eine Übereinstimmung von nur 49,1 % mit dem Konisat unabhängig von Alter, Transformationszone oder Menopausenstatus. Schlussfolgerung: Die Treffsicherheit der kolposkopisch gestützten Biopsie scheint sich durch die Entnahme von 3 Proben steigern zu lassen und besitzt eine sehr hohe Aussagekraft vor allem für jüngere Patientinnen. Auch die Differenzialzytologie zeigt eine hohe Treffsicherheit und kann insbesondere bei Patientinnen über 50 Jahren von Nutzen sein. Die ECC liegt mit ihrer Treffsicherheit deutlich darunter, kann aber in ausgewählten Fällen wichtige zusätzliche Informationen liefern.

Key words

virus infection - cervical cancer - cervical intraepithelial neoplasia (CIN) - cervix

Schlüsselwörter

Virusinfektion - Gebärmutterhalskrebs - zervikale intraepitheliale Neoplasie - Gebärmutterhals

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