Abstract 10P
Background
Our objective was to investigate the diagnostic efficacy of colposcopy-guided biopsy (CGB) and to explore new strategies to increase the accuracy for detecting cervical intraepithelial neoplasia grade 2 or more severe lesions.
Methods
We conducted a retrospective cohort study of 550 women who underwent both CGB and surgery to assess the consistency of their pathological findings. 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 for CIN2+ and CIN3+ lesions on definitive pathology. The AUC was utilized to evaluate the diagnostic performance of detecting CIN2+ and CIN3+ lesions on surgical pathology with various variables.
Results
Among 550 women with paired CGB/surgical pathology, 53.5% (294/550) had perfect agreement, with 17.1% (94/550) underestimations and 29.5% (162/550) overestimations. The sensitivity and specificity of CGB for detecting CIN2+ lesions were 86.3% (276/320) and 51.3% (118/230), respectively. Multivariate logistic analysis revealed that CGB confirming 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 HPV integration-positive (OR, 2.2; 95% CI, 1.3-3.5; P < 0.001) were significant predictors for CIN2+ on surgical pathology. For identifying CIN3+, CGB confirming 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), HPV integration-positive (OR, 2.0; 95% CI, 1.3-3.1; P = 0.003) were independent predictors. The AUCs increased when incorporating several variables to predict high-grade lesions. For 27 patients with both high-grade-cytology and HPV integration-positive results, 25 (92.6%) of them confirmed CIN2+ on definitive pathology.
Conclusions
CGB's accuracy is limited, leading to underestimations and overestimations. Combining CGB with HPV integration and cytology enhances CIN2+ and CIN3+ diagnosis. Diagnostic conisation may be considered for patients with high-grade cytology and HPV integration-positive results.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.