Archives of Gynecology and Obstetrics

, Volume 296, Issue 5, pp 965–972 | Cite as

Analysis of clinical factors correlated with the accuracy of colposcopically directed biopsy

  • Aiping Fan
  • Liqin Zhang
  • Chen Wang
  • Yingmei Wang
  • Cha Han
  • Fengxia Xue
General Gynecology
First Online:
Received:
Accepted:
  • 119 Downloads

Abstract

Purpose

Many factors affect the accuracy of colposcopically directed biopsy (CDB). This study aimed to compare the histological results of CDB with those of cone specimens and to determine clinical factors associated with the accuracy of CDB in defining the extent and severity of cervical intraepithelial neoplasia.

Methods

We studied 513 patients diagnosed with cervical intraepithelial neoplasia by CDB who underwent conization between September 2012 and December 2016. We retrospectively evaluated the agreement between histological results on biopsies and cone specimens and analyzed factors influencing the accuracy of the results.

Results

The overall agreement between the histological results on biopsy and the corresponding cone specimens was 74.1%; underestimation occurred in 6.4% of cases. The agreement between histological results on biopsy and cone specimen was 54.5% for low-grade lesions, 78.2% for high-grade lesions, and 28.9% for microinvasive cervical cancer. The overall agreement between high-grade cytology and the final histological diagnosis was 86.7%. By univariate analysis, patient age (p = 0.026), menopausal status (p = 0.018), type of transformation zone (p = 0.003), number of biopsies (p = 0.002), and cone width (p = 0.015) were found to be associated with the accuracy of CDB. However, multivariate logistic regression revealed that cone width (p = 0.044) was the only independent factor correlated with CDB accuracy.

Conclusions

Our data suggest that old age (≥50), postmenopausal status, and transformation zone type 3 might be positively associated with the under-diagnosis of CDB. Three or more biopsies and cone width ≥21 mm might improve CDB accuracy. However, cone width was the only independent factor correlated with CDB accuracy.

Keywords

Cervical intraepithelial neoplasia Colposcopically directed biopsy Conization Accuracy Clinical factors 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

We thank Dr. Tao Shi of the Department of Pathology for Tianjin Medical University General Hospital for his help in the data collection.

Authors’ contributions

Aiping Fan: data collection and manuscript writing; Liqin Zhang: data collection and manuscript writing; Chen Wang: data collection and analysis; Yingmei Wang: data analysis; Cha Han: data collection; Fengxia Xue: project development and manuscript revision.

Compliance with ethical standards

Conflict of interest

We declare that there are no conflicts of interest relevant to this article.

Ethical approval

This type of retrospective study did not involve the diagnosis and treatment of patients. Thus, the ethics committee of Tianjin Medical University General Hospital waived the need for an informed consent. The institutional review board of Tianjin Medical University General Hospital approved this study (IRB approval number: 2017-YX-022).

References

  1. 1.
    Underwood M, Arbyn M, Parry-Smith W, De Bellis-Ayres S, Todd R, Redman CW, Moss EL (2012) Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG 119(11):1293–1301CrossRefPubMedGoogle Scholar
  2. 2.
    Ouitraul S, Udomthavornsuk B, Chumworathavi B, Luanratanakom S, Supoken A (2011) Accuracy of colposcopically directed biopsy in diagnosis of cervical pathology at Srinagarind Hospital. Asian Pac J Cancer Prev 12(9):2451–2453Google Scholar
  3. 3.
    Siegler E, Bornstein J, Network Israeli Colposcopy (2011) Loop electrosurgical excision procedures in Israel. Gynecol Obstet Invest 72:85–89CrossRefPubMedGoogle Scholar
  4. 4.
    Kabaca C, Koleli I, Sariibrahim B, Karateke A, Gurbuz A, Kapudere B, Cetiner H, Cesur S (2014) Is cervical punch biopsy enough for the management of low-grade cervical intraepithelial neoplasia? J Low Genit Tract Dis 18(3):240–245CrossRefPubMedGoogle Scholar
  5. 5.
    Zuchna C, Hager M, Tringler B, Georgoulopoulos A, Ciresa-Koenig A, Volgger B, Widschwendter A, Staudach A (2010) Diagnostic accuracy of guided cervical biopsies: a prospective multicenter study comparing the histopathology of simultaneous biopsy and cone specimen. Am J Obstet Gynecol 203(4):321.e1-6CrossRefPubMedGoogle Scholar
  6. 6.
    Sørbye SW, Arbyn M, Fismen S, Gutteberg TJ, Mortensen ES (2011) HPV E6/E7 mRNA testing is more specific than cytology in post-colposcopy follow-up women with negative cervical biopsy. PLoS ONE 6(10):e26022CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Moss EL, Hadden P, Douce G, Jones PW, Arbyn M, Redman CW (2012) Is the colposcopically directed punch biopsy a reliable diagnostic test in women with minor cytological lesions? J Low Genit Tract Dis 16(4):421–426CrossRefPubMedGoogle Scholar
  8. 8.
    Boicea A, Pătraşcu A, Surlin V, Iliescu D, Schenker M, Chiuţu L (2012) Correlations between colposcopy and histologic results from colposcopically directed biopsy in cervical precancerous lesions. Rom J Morphol Embryol 53(3 Suppl):735–741PubMedGoogle Scholar
  9. 9.
    Xiao FY, Wang Q, Zheng RL, Chen M, Su TT, Sui L (2016) Diagnosis and treatment value of colposcopy and loop electrosurgical excision procedure in microinvasive cervical cancer: analysis of 135 cases (Article in Chinese). Zhonghua Fu Chan Ke Za Zhi 51(3):186–191PubMedGoogle Scholar
  10. 10.
    Chen RJ, Chang DY, Yen ML, Lee EF, Chow SN, Huang SC, Hsieh CY (1995) Independent clinical factors which correlate with failures in diagnosing early cervical cancer. Gynecol Oncol 58(3):356–361CrossRefPubMedGoogle Scholar
  11. 11.
    Baldauf JJ, Dreyfus M, Ritter J, Philippe E (1997) An analysis of the factors involved in the diagnostic accuracy of colposcopically directed biopsy. Acta Obstet Gynecol Scand 76(5):468–473CrossRefPubMedGoogle Scholar
  12. 12.
    Barker B, Garcia F, Lozevski J, Warner J, Hatch K (2001) The correlation between colposcopically directed cervical biopsy and loop electrosurgical excision procedure pathology and the effect of time on that agreement. Gynecol Oncol 82(1):22–26CrossRefPubMedGoogle Scholar
  13. 13.
    Costa S, Nuzzo MD, Rubino A, Rambelli V, Marinelli M, Santini D, Cristiani P, Bucchi L (2003) Independent determinants of colposcopically directed punch biopsy of the cervix. Gynecol Oncol 90(1):57–63CrossRefPubMedGoogle Scholar
  14. 14.
    Müller K, Soergel P, Hillemanns P, Jentschke M (2016) Accuracy of colposcopically guided diagnostic methods for the detection of cervical intraepithelial neoplasia. Geburtshilfe Frauenheikkd 76(2):182–187CrossRefGoogle Scholar
  15. 15.
    Bifulco G, De Rosa N, Lavitola G, Piccoli R, Bertrando A, Natella V, Di Carlo C, Insabato L, Nappi C (2015) A prospective randomized study on limits of colposcopy and histology: the skill of colposcopist and colposcopy-guided biopsy in diagnosis of cervical intraepithelial lesions. Infect Agent Cancer 10:47. doi: 10.1186/s13027-015-0042-9 (eCollection 2015) CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Vercellino GF, Erdemoglu E, Kyeyamwa S, Drechsler I, Vasiljeva J, Cichon G, Schneider A (2011) Evaluation of the VITOM in digital high-definition video exocolposcopy. J Low Genit Tract Dis 15(4):292–295CrossRefPubMedGoogle Scholar
  17. 17.
    Schneider A, Rakozy C, Stolte C, Bothur-Schhäfer P, Rothe H, Welcker T, Choly N, Roesgen A, Böhmer G (2015) Correlation between VITOM(®) videocolposcopy and histopathology for pathognomonic grading criteria. Arch Gynecol Obstet 292(6):1361–1366CrossRefPubMedGoogle Scholar
  18. 18.
    Wang C, Zheng W, Bu Y, Chang S, Zhang S, Xu RX (2016) Multi-scale hyperspectral imaging of cervical neoplasia. Arch Gynecol Obstet 293(6):1309–1317CrossRefPubMedGoogle Scholar
  19. 19.
    Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M, Perrotta M, Prendiville W, Russell P, Sideri M, Strander B, Tatti S, Torne A, Walker P (2012) 2011 colposcopic terminology of the international federation for cervical pathology and colposcopy. Obstet Gynecol 120(1):166–172CrossRefPubMedGoogle Scholar
  20. 20.
    Darragh TM, Colgan TJ, Cox JT, Heller DS, Henry MR, Luff RD, McCalmont T, Nayar R, Palefsky JM, Stoler MH, Wilkinson EJ, Zaino RJ, Wilbur DC, Members of LAST Project Work Groups (2012) 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. J Lower Genit Tract Dis 16(3):205–242CrossRefGoogle Scholar
  21. 21.
    Dobbs SP, Hewett PW, Johnson IR, Carmichael J, Murray JC (1997) Angiogenesis is associated with vascular endothelial growth factor expression in cervical intraepithelial neoplasia. Br J Cancer 76(11):1410–1415CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Dobbs SP, Brown LJ, Ireland D, Abrams KR, Murray JC, Gatter K, Harris A, Steward WP, O’Byrne KJ (2000) Platelet-derived endothelial cell growth factor expression and angiogenesis in cervical intraepithelial neoplasia and squamous cell carcinoma of the cervix. Ann Diagn Pathol 4(5):286–292CrossRefPubMedGoogle Scholar
  23. 23.
    Isaka S, Sawai K, Tomiie M, Kamiura S, Koyama M, Azuma C, Ishiguro S, Murata Y, Saji F (2002) Expression of platelet-derived endothelial cell growth factor/thymidine phosphorylase in cervical intraepithelial neoplasia. Int J Oncol 21(2):281–287PubMedGoogle Scholar
  24. 24.
    Wentzensen N, Zuna RE, Sherman ME, Gold MA, Schiffman M, Dunn ST, Jeronimo J, Zhang R, Walker J, Wang SS (2009) Accuracy of cervical specimens obtained for biomarker studies in women with CIN3. Gynecol Oncol 115(3):493–496CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Cheng X, Feng Y, Wang X, Wan X, Xie X, Lu W (2013) The effectiveness of conization treatment cervical intraepithelial neoplasia. Exp Ther Med 5(1):185–188CrossRefPubMedGoogle Scholar
  26. 26.
    Diedrich JT, Felix JC, Lonky NM (2014) Do colposcopically directed biopsy and endocervical curettage serve to induce regression of cervical intraepithelial neoplasia? J Low Genit Tract Dis 18(4):322–325CrossRefPubMedGoogle Scholar
  27. 27.
    Solomon D, Stoler M, Jeronimo J, Khan M, Castle P, Schiffman M (2007) Diagnostic utility of endocervical curettage in women undergoing colposcopy for equivocal or low-grade cytologic abnormalities. Obstet Gynecol 110(2 Pt 1):288–295CrossRefPubMedGoogle Scholar
  28. 28.
    Nakamura Y, Matsumoto K, Satoh T, Nishide K, Nozue A, Shimabukuro K, Endo S, Nagai K, Oki A, Minaguchi T, Morishita Y, Noguchi M, Yoshikawa H (2015) Optimizing biopsy procedures during colposcopy for women with abnormal cervical cancer screening results: a multicenter prospective study. Int J Clin Oncol 20(3):579–585CrossRefPubMedGoogle Scholar
  29. 29.
    Wentzensen N, Walker JL, Gold MA, Smith KM, Zuna RE, Mathews C, Dunn ST, Zhang R, Moxley K, Bishop E, Tenney M, Nugent E, Graubard BI, Wacholder S, Schiffman MJ (2015) Multiple biopsies and detection of cervical cancer precursors at colposcopy. Clin Oncol 33(1):83–89CrossRefGoogle Scholar
  30. 30.
    Furber SE, Weisberg E, Simpson JM (1997) Progression and regression of low-grade epithelial abnormalities of the cervix. Aust N Z J Obstet Gynaecol 37(1):107–112CrossRefPubMedGoogle Scholar
  31. 31.
    Ciavattini A, Clemente N, Tsiroglou D, Sopracordevole F, Serri M, Delli Carpini G, Papiccio M, Cattani P (2017) Follow up in women with biopsy diagnosis of cervical low-grade squamous intraepithelial lesion (LSIL): how long should it be? Arch Gynecol Obstet 295(4):997–1003CrossRefPubMedGoogle Scholar
  32. 32.
    Massad LS, Halperin CJ, Bitterman P (1996) Correlation between colposcopically directed biopsy and cervical loop excision. Gynecol Oncol 60(3):400–403CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsTianjin Medical University General HospitalTianjinChina

Personalised recommendations