Diagnostic value of colposcopy for cervical intraepithelial neoplasia 2–3/carcinoma in situ and microinvasive cervical cancerстатья
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Дата последнего поиска статьи во внешних источниках: 3 февраля 2022 г.
Аннотация:Objective: The aim of this study was to assess the diagnostic value ofcolposcopy for the diagnosis of cervical intraepithelial neoplasia 2–3/carcinoma in situ and microinvasive cervical cancer. Methods: Sensitivity, positive predictive value, and rate of false negative results ofcolposcopy were calculated in 718 patients with verified cervical intraepithelial neoplasia 2–3/carcinoma in situ and microinvasive cervical cancer. Assessment was made after final histological verification referring to the estimated diagnosis at colposcopic examinationbased on International Federation for Cervical Pathology and Colposcopy criteria. Results: A full agreement of colposcopic and morphological diagnosis was observed in 329 of 718 cases, resulting in acolposcopy sensitivity of 45.8% for the diagnosis of cervical intraepithelial neoplasia 2–3/carcinoma in situ and microinvasive cervicalcancer. A type 3 transformation zone, dominant in patients with cervical intraepithelial neoplasia 2–3/carcinoma in situ and microinvasive cervical cancer, regardless of age and neoplasia grade (observedin 81.3% of patients included in the study), and a high rate of acetowhite lesions that were not visible (36.6% of patients) limited thesensitivity of colposcopy and colposcopy-guided biopsy, resulting inunderdiagnosis, even in young patients. The risk of underdiagnosisgrew significantly in women older than 30 years because of the growing incidence of non-visible acetowhite lesions (p = 0.01). This studysuggests that large loop excision of the transformation zone may berecommended as an optimal diagnostic procedure in women withhigh grade squamous intraepithelial lesion (HSIL)+ cytology, evenin the absence of lesions at colposcopy. Conclusion: Colposcopy andcolposcopy-guided biopsies are not always sensitive enough to assess maximal degree and even the presence of cervical neoplasia.This study suggests that large loop excision of the transformationzone may be recommended as an optimal diagnostic procedure inwomen with HSIL+ cytology, even in the absence of lesions at colposcopy.Keyword