Editor's note: From June 20 to 22, 2024, the European Society for Medical Oncology (ESMO) Gynecologic Oncology Congress was held in Florence, Italy. "Human Papillomavirus (HPV) Integrated Detection and High-level Cytology Improve the Diagnostic Performance of Colposcopy-Guided Biopsy" shared by the team of Tongji Hospital of Huazhong University of Science and Technology at this conference.
background
Our aim was to investigate the diagnostic effects of colposcopy-guided biopsy (CGB) and to explore new strategies to improve the accuracy of detecting cervical intraepithelial neoplasia grade 2 or worse.
way
We conducted a retrospective cohort study of 550 women who underwent both CGB surgery and surgery to assess the consistency of their pathological results. Using surgical pathology as the gold standard, we evaluated the diagnostic accuracy of CGB in detecting high-grade lesions. Univariate and multivariate logistic regression analyses were used to identify independent predictors of pathologically CIN2+ and CIN3+ lesions. AUC was used to evaluate the diagnostic performance of detecting CIN2+ and CIN3+ lesions in surgical pathology using different variables.
outcome
Of the 550 women paired with CGB/surgical pathology, 53.5% (294/550) had complete agreement, 17.1% (94/550) were underestimated, and 29.5% (162/550) were overestimated. The sensitivity and specificity of CGB for the detection of CIN2+ lesions were 86.3% (276/320) and 51.3% (118/230), respectively. Multivariate logistic analysis showed that CGB confirmed that CIN2+ (OR, 6.0; 95% CI, 3.9-9.1; P < 0.001), high-grade cytology (OR, 2.6; 95% CI, 1.4-4.9; P = 0.003), and positive HPV integration (OR, 2.2; 95% CI, 1.3-3.5; P < 0.001) were significant predictors of CIN2+ in surgical pathology. In terms of CIN3+ recognition, CGB confirmed CIN2+ (OR, 5.3; 95% CI, 3.4-8.3; P < 0.001), high-grade cytology (OR, 2.6; 95% CI, 1.5-4.7; P = 0.001), and positive HPV integration (OR, 2.0; 95% CI, 1.3-3.1; P = 0.003) as independent predictors. AUC increases when several variables are combined to predict high-grade lesions. Of the 27 patients with both high-grade cytology and HPV integration positive results, 25 (92.6%) confirmed CIN2+ on the definitive pathology.
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conclusion
CGB has limited accuracy, leading to underestimation and overestimation. Combining CGB with HPV integration and cytology can enhance the diagnosis of CIN2+ and CIN3+. Diagnostic conization may be considered in patients with high-grade positive results on cytology and HPV integration.
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