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Correlation between referral cytology and in-house colposcopy-guided cytology for detecting early cervical neoplasia

  • Gynecologic Oncology
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Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

The current cervical cancer screening program in Germany recommends that the results showing suspected HPV infection should be further examined in specialized colposcopy units. This study aimed to correlate externally documented Pap smear results with in-house colposcopy-guided Pap cytology results and compare colposcopy-guided biopsy and postoperative histopathology results.

Methods

Clinical data were analyzed from 3627 examinations in 2844 patients who visited a university certified dysplasia unit from 2014 to 2017; 2212 patients underwent complete assessments, including Pap smear, colposcopy, HPV testing, colposcopy-guided biopsy, and/or surgery. The results were analyzed descriptively.

Results

External and in-house Pap results were consistent in 1054 ofthe 2212 patients (47.65%). Referral cytology showed a higher grade than in-house in 456 (20.61%) and a lower grade in 702 (31.74%). Using the histopathological findings as the gold standard, overdiagnosis in the referral cytology was noted in 180 patients (13.19%), underdiagnosis in 263 (19.27%), and concordant findings in 922 (67.55%). For in-house cytology, overdiagnosis was found in 133 patients (10.74%), underdiagnosis in 192 (15.51%), and accurate diagnosis with congruent cytology and histopathology findings in 913 (73.75%).

Conclusions

The rate of detection of cervical abnormalities differs significantly depending on whether the examination is performed routinely or in specialized units. Colposcopy-guided Pap smears correlate significantly better with histology than referral cytology results without colposcopic guidance. More severe lesions were also detected more accurately.

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References

  1. Barnes B, Bertz J, Buttmann-Schweiger N, Fiebig J, Jordan S, Kraywinkel K et al (2016) Gebärmutterhalskrebs (C53). Bericht zum Krebsgeschehen in Deutschland 2016. Robert Koch Institut, Berlin, pp 72–77. https://www.bundesgesundheitsministerium.de/fileadmin/Dateien/3_Downloads/K/Krebs/Krebsgeschehen_RKI.pdf. Accessed 15 Feb 2019

  2. World Health Organization (2016) UN Joint Global Programme on Cervical Cancer Prevention and Control [leaflet]. World Health Organization, Geneva. https://www.who.int/ncds/un-task-force/un-joint-action-cervical-cancer-leaflet.pdf?ua=1. Accessed 15 Feb 2019

  3. Boshart M, Gissmann L, Ikenberg H, Kleinheinz A, Scheurlen W, zur Hausen H (1984) A new type of papillomavirus DNA, its presence in genital cancer biopsies and in cell lines derived from cervical cancer. EMBO J 3(5):1151–1157

    Article  CAS  Google Scholar 

  4. Müller K, Soergel P, Hillemanns P, Jentschke M (2016) Accuracy of colposcopically guided diagnostic methods for the detection of cervical intraepithelial neoplasia. Geburtshilfe Frauenheilkd 76:182–187. https://doi.org/10.1055/s-0041-111504

    Article  PubMed  PubMed Central  Google Scholar 

  5. Olaniyan OB (2002) Validity of colposcopy in the diagnosis of early cervical neoplasia—a review. Afr J Reprod Health 6:59–69

    Article  Google Scholar 

  6. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2014) S3-Leitlinie Diagnostik, Therapie und Nachsorge der Patientin mit Zervixkarzinom, Langversion, 1.0, 2014, AWMF-Registernummer: 032/033OL. Stand: 23.04.2018. Office des Leitlinienprogrammes Onkologie/Deutsche Krebsgesellschaft, Berlin. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Zervixkarzinom/LL_Zervixkarzinom_Langversion_1.0.pdf. Accessed 15 Feb 2019

  7. Beckmann MW, Quaas J, Bischofberger A, Kämmerle A, Lux MP, Wesselmann S (2014) Establishment of the certification system “gynaecological dysplasia” in Germany. Geburtshilfe Frauenheilkd 74:860–867. https://doi.org/10.1055/s-0034-1383042

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hillemanns P, Mallmann P, Beckmann MW, Gynecology Oncology Working Group (AGO) (2016) New screening proposals: the Federal Joint Commission defines the parameters for cervical cancer screening from 2018: statement of the Gynecology Oncology Working Group (AGO). Geburtshilfe Frauenheilkd 76:145–146. https://doi.org/10.1055/s-0035-1568209

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Hillemanns P et al (2019) Prevention of cervical cancer: guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017)—part 1 with introduction, screening and the pathology of cervical dysplasia. Geburtshilfe Frauenheilkd 79(2):148–159. https://doi.org/10.1055/a-0818-5440

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hillemanns P et al (2019) Prevention of cervical cancer: guideline of the DGGG and the DKG (S3 Level, AWMF Register Number 015/027OL, December 2017)—part 2 on triage, treatment and follow-up. Geburtshilfe Frauenheilkd 79(2):160–176. https://doi.org/10.1055/a-0828-7722

    Article  PubMed  PubMed Central  Google Scholar 

  11. Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M et al (2012) 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol 120:166–172. https://doi.org/10.1097/AOG.0b013e318254f90c

    Article  PubMed  Google Scholar 

  12. Motamedi M, Böhmer G, Neumann HH, von Wasielewski R (2015) CIN III lesions and regression: retrospective analysis of 635 cases. BMC Infect Dis 15:541. https://doi.org/10.1186/s12879-015-1277-1

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Quaas J, Reich O, Küppers V (2014) Explanation and use of the Rio 2011 colposcopy nomenclature of the IFCPC (International Federation for Cervical Pathology and Colposcopy): comments on the general colposcopic assessment of the uterine cervix: adequate/inadequate; squamocolumnar junction; transformation zone. Geburtshilfe Frauenheilkd 74:1090–1092. https://doi.org/10.1055/s-0034-1383216

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Liverani CA, Di Giuseppe J, Clemente N, Delli Carpini G, Monti E, Fanetti F, Bolis G, Ciavattini A (2016) Length but not transverse diameter of the excision specimen for high-grade cervical intraepithelial neoplasia (CIN 2–3) is a predictor of pregnancy outcome. Eur J Cancer Prev 25:416–422. https://doi.org/10.1097/CEJ.0000000000000196

    Article  PubMed  Google Scholar 

  15. Arbyn M, Kyrgiou M, Simoens C, Raifu AO, Koliopoulos G, Martin-Hirsch P, Prendiville W, Paraskevaidis E (2008) Perinatal mortality and other severe adverse pregnancy outcomes associated with treatment of cervical intraepithelial neoplasia: meta-analysis. BMJ 337:a1284. https://doi.org/10.1136/bmj.a1284

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Shaughnessy AF (2015) CIN treatment may increase miscarriages but does not affect fertility. Am Fam Phys 91:490. https://www.aafp.org/afp/2015/0401/p490.html. Accessed 15 Feb 2019

  17. Kyrgiou M, Athanasiou A, Kalliala IEJ, Paraskevaidi M, Mitra A, Martin-Hirsch PP, Arbyn M, Bennett P, Paraskevaidis E (2017) Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev 11:CD012847. https://doi.org/10.1002/14651858.CD012847

    Article  PubMed  Google Scholar 

  18. Matsuura Y, Kawagoe T, Toki N, Sugihara K, Kashimura M (1996) Early cervical neoplasia confirmed by conization: diagnostic accuracy of cytology, colposcopy and punch biopsy. Acta Cytol 40(2):241–246

    Article  CAS  Google Scholar 

  19. R Foundation for Statistical Computing (2017) R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing. https://www.R-project.org. Accessed 15 Feb 2019

  20. Link M, Link H (2003) Neun goldene Regeln zur Qualitätsverbesserung der gynäkologischen Exfoliativzytologie. Frauenarzt 44:1256–1262

    Google Scholar 

  21. Marquardt K, Kolankowska I, Pfandzetter R (2014) Jahresstatistik Zervix-Zytologie. Frauenarzt 55(8):732–733

    Google Scholar 

  22. O’Connor M, Sharp L et al (2017) Physical after.effects of colposcopy and related procedures, and their inter-relationship with psychological distress: a longitudinal survey. BJOG 124(9):1402–1410

    Article  Google Scholar 

  23. Khan MJ, Huh WK et al (2017) ASCCP colposcopy standards: role of colposcopy, benefits, potential harms, and terminology for colposcopic pratice. J Low Genit Tract Dis 21(4):223–229

    Article  Google Scholar 

  24. Baum ME, Rader JS, Gibb RK, McAlister RP, Powell MA, Mutch DG et al (2006) Colposcopic accuracy of obstetrics and gynecology residents. Gynecol Oncol 103:966–970

    Article  Google Scholar 

  25. Vercellino GF, Erdemoglu E (2015) What should be the goal for future development of colposcopy? Cons and pros of sensitivity and specificity. Arch Gynecol Obstet 291:713–714

    Article  Google Scholar 

  26. Stuebs FA, Koch MC et al (2019) Accuracy of colposcopy-directed biopsy in detecting early cervical neoplasia: a retrospective study. Arch Gynecol Obstet 299(2):525–532

    Article  Google Scholar 

  27. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF). Prävention des Zervixkarzinoms, Langversion 1.0, 2017, AWMF Registernummer: 015/027OL. Berlin: Office des Leitlinienprogrammes Onkologie/Deutsche Krebsgesellschaft; 2017. https://www.leitlinienprogramm-onkologie.de/fileadmin/user_upload/Downloads/Leitlinien/Zervixkarzinom_Praevention/LL_Pr%C3%A4vention_des_Zervixkarzinoms_Langversion_1.0.pdf. Accessed Feb 2019

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Acknowledgements

Research for the present study was performed in (partial) fulfillment of the requirements for obtaining the degree of Doctor of Medicine by Ms. Carla Emilia Schulmeyer. The authors are grateful to Mr. Michael Robertson for professional medical editing services.

Funding

No specific funding was received for this study.

Author information

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Friedrich–Alexander-University Erlangen–Nuremberg (FAU), Universitätsstrasse 21–23, 91054, Erlangen, Germany

    Carla E. Schulmeyer, Frederik Stübs, Paul Gass, Simone K. Renner, Grit Mehlhorn, Matthias W. Beckmann & Martin C. Koch

  2. Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER–EMN), Universitätsstrasse 21–23, 91054, Erlangen, Germany

    Carla E. Schulmeyer, Frederik Stübs, Paul Gass, Simone K. Renner, Grit Mehlhorn, Matthias W. Beckmann & Martin C. Koch

  3. Department of Gynecology and Obstetrics, Klinikum Sindelfingen-Böblingen, Bunsenstrasse 120, 71032, Böblingen, Germany

    Simone K. Renner

  4. Institute of Pathology, Erlangen University Hospital, Comprehensive Cancer Center Erlangen/European Metropolitan Area Nuremberg (CCC ER–EMN), Erlangen, Germany

    Arndt Hartmann, Johanna Strehl, Grit Mehlhorn & Carol Geppert

  5. Department of Medical Informatics, Biometry and Epidemiology, Friedrich–Alexander-University Erlangen–Nuremberg, Waldstrasse 6, 91054, Erlangen, Germany

    Werner Adler

Authors
  1. Carla E. Schulmeyer
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  2. Frederik Stübs
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  10. Matthias W. Beckmann
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  11. Martin C. Koch
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Contributions

CES, FS, MCK, GM, PG, and SKR contributed substantially to data acquisition and revised it critically for important intellectual content. CES, FS, MCK, MWB, GM, SKR, AH, JS, WA, and CG substantially contributed to the conception and design of the study and interpretation of data and revised it critically for important intellectual content. CES, MCK, and MWB substantially contributed to data acquisition, analysis, and interpretation of the data, as well as the conception of the study and drafting of the article. All of the authors have given final approval for publication of the present version.

Corresponding author

Correspondence to Carla E. Schulmeyer.

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Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

The study was performed in accordance with the Declaration of Helsinki. Approval from the regional ethics committee (Friedrich–Alexander-University Erlangen–Nuremberg, Erlangen) was not necessary due to the retrospective nature of the research.

Informed consent

An informed consent was not necessary due to the projects’ retrospective analysis of an anonymized data research.

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Supplementary Fig. 1. Array of the histopathological findings (DOCX 31 kb)

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Schulmeyer, C.E., Stübs, F., Gass, P. et al. Correlation between referral cytology and in-house colposcopy-guided cytology for detecting early cervical neoplasia. Arch Gynecol Obstet 301, 263–271 (2020). https://doi.org/10.1007/s00404-019-05389-1

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  • DOI: https://doi.org/10.1007/s00404-019-05389-1

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