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BMC Cancer
Published in: BMC Cancer 1/2023

Open Access 01-12-2023 | Colposcopy | Research

Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology

Authors: Dongxu Qin, Anying Bai, Peng Xue, Samuel Seery, Jiaxu Wang, Maria Jose Gonzalez Mendez, Qing Li, Yu Jiang, Youlin Qiao

Published in: BMC Cancer | Issue 1/2023

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Abstract

Background

Colposcopy is an important tool in diagnosing cervical cancer, and the International Federation of Cervical Pathology and Colposcopy (IFCPC) issued the latest version of the guidelines in 2011. This study aims to systematically assess the accuracy of colposcopy in predicting low-grade squamous intraepithelial lesions or worse (LSIL+) / high-grade squamous intraepithelial lesions or worse (HSIL+) under the 2011 IFCPC terminology.

Methods

We performed a systematic review and meta-analysis, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for studies about the performance of colposcopy in diagnosing cervical intraepithelial neoplasia under the new IFCPC colposcopy terminology from PubMed, Embase, Web of Science and the Cochrane database. Data were independently extracted by two authors and an overall diagnostic performance index was calculated under two colposcopic thresholds.

Results

Totally, fifteen articles with 22,764 participants in compliance with the criteria were included in meta-analysis. When colposcopy was used to detect LSIL+, the combined sensitivity and specificity were 0.92 (95% CI 0.88–0.95) and 0.51 (0.43–0.59), respectively. When colposcopy was used to detect HSIL+, the combined sensitivity and specificity were 0.68 (0.58–0.76) and 0.93 (0.88–0.96), respectively.

Conclusion

In accordance with the 2011 IFCPC terminology, the accuracy of colposcopy has improved in terms of both sensitivity and specificity. Colposcopy is now more sensitive with LSIL+ taken as the cut-off value and is more specific to HSIL+. These findings suggest we are avoiding under- or overdiagnosis both of which impact on patients’ well-being.
Appendix
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Literature
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRefPubMed
2.
Brisson M, Drolet M. Global elimination of cervical cancer as a public health problem. Lancet Oncol. 2019;20(3):319–21.PubMedCrossRef
3.
Xue P, Ng MTA, Qiao Y. The challenges of colposcopy for cervical cancer screening in LMICs and solutions by artificial intelligence. BMC Med. 2020;18(1):169.PubMedPubMedCentralCrossRef
4.
Bornstein J, Bentley J, Bösze P, Girardi F, Haefner H, Menton M, Perrotta M, Prendiville W, Russell P, Sideri M, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012;120(1):166–72.PubMedCrossRef
5.
Quaas J, Reich O, Frey Tirri B, Küppers V. Explanation and use of the colposcopy terminology of the IFCPC (International Federation for Cervical Pathology and Colposcopy) Rio 2011. Geburtshilfe Frauenheilkd. 2013;73(9):904–7.PubMedPubMedCentralCrossRef
6.
Tatti S, Bornstein J, Prendiville W. Colposcopy: a global perspective: introduction of the new IFCPC colposcopy terminology. Obstet Gynecol Clin North Am. 2013;40(2):235–50.PubMedCrossRef
7.
8.
Li Y, Duan X, Sui L, Xu F, Xu S, Zhang H, Xu C. Closer to a Uniform Language in Colposcopy: Study on the Potential Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology in Clinical Practice. Biomed Res Int. 2017;2017:8984516.PubMedPubMedCentral
9.
Fan A, Wang C, Zhang L, Yan Y, Han C, Xue F. Diagnostic value of the 2011 international federation for cervical pathology and colposcopy terminology in predicting cervical lesions. Oncotarget. 2018;9(10):9166.PubMedPubMedCentralCrossRef
10.
Rema PN, Mathew A, Thomas S. Performance of colposcopic scoring by modified International Federation of Cervical Pathology and Colposcopy terminology for diagnosing cervical intraepithelial neoplasia in a low-resource setting. South Asian J Cancer. 2019;8(4):218–20.PubMedPubMedCentralCrossRef
11.
Vercellino GF, Erdemoglu E, Chiantera V, Vasiljeva K, Malak AH, Schneider A, Böhmer G. Clinical relevance of objectifying colposcopy. Arch Gynecol Obstet. 2015;291(4):907–15.PubMedCrossRef
12.
Soutter WP, Diakomanolis E, Lyons D, Ghaem-Maghami S, Ajala T, Haidopoulos D, Doumplis D, Kalpaktsoglou C, Sakellaropoulos G, Soliman S, et al. Dynamic spectral imaging: improving colposcopy. Clin Cancer Res. 2009;15(5):1814–20.PubMedCrossRef
13.
Tanaka Y, Ueda Y, Kakubari R, Kakuda M, Kubota S, Matsuzaki S, Okazawa A, Egawa-Takata T, Matsuzaki S, Kobayashi E, et al. Histologic correlation between smartphone and coloposcopic findings in patients with abnormal cervical cytology: experiences in a tertiary referral hospital. Am J Obstet Gynecol. 2019;221(3):241.e241-241.e246.CrossRef
14.
Hu L, Bell D, Antani S, Xue Z, Yu K, Horning MP, Gachuhi N, Wilson B, Jaiswal MS, Befano B, et al. An Observational Study of Deep Learning and Automated Evaluation of Cervical Images for Cancer Screening. J Natl Cancer Inst. 2019;111(9):923–32.PubMedPubMedCentralCrossRef
15.
Xue P, Tang C, Li Q, Li Y, Shen Y, Zhao Y, Chen J, Wu J, Li L, Wang W, et al. Development and validation of an artificial intelligence system for grading colposcopic impressions and guiding biopsies. BMC Med. 2020;18(1):406.PubMedPubMedCentralCrossRef
16.
Mueller JL, Lam CT, Dahl D, Asiedu MN, Krieger MS, Bellido-Fuentes Y, Kellish M, Peters J, Erkanli A, Ortiz EJ, et al. Portable Pocket colposcopy performs comparably to standard-of-care clinical colposcopy using acetic acid and Lugol’s iodine as contrast mediators: an investigational study in Peru. BJOG. 2018;125(10):1321–9.PubMedPubMedCentralCrossRef
17.
Lam CT, Mueller J, Asma B, Asiedu M, Krieger MS, Chitalia R, Dahl D, Taylor P, Schmitt JW, Ramanujam N. An integrated strategy for improving contrast, durability, and portability of a Pocket Colposcope for cervical cancer screening and diagnosis. PLoS ONE. 2018;13(2):e0192530.PubMedPubMedCentralCrossRef
18.
19.
Abdul-Karim FW, Yang B. Cytologic-Histologic Discrepancies in Pathology of the Uterine Cervix: Analysis of the Clinical and Pathologic Factors. Adv Anat Pathol. 2017;24(5):304–9.PubMedCrossRef
20.
Mayeaux EJ Jr, Novetsky AP, Chelmow D, Choma K, Garcia F, Liu AH, Papasozomenos T, Einstein MH. Systematic Review of International Colposcopy Quality Improvement Guidelines. J Low Genit Tract Dis. 2017;21(4):249–57.PubMedCrossRef
21.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. 2011;155(8):529–36.PubMedCrossRef
22.
Coronado PJ, Fasero M. Colposcopy combined with dynamic spectral imaging. A prospective clinical study. Eur J Obstet Gynecol Reprod Biol. 2016;196:11–6.PubMedCrossRef
23.
Del Pino M, Angeles MA, Martí C, Henere C, Munmany M, Marimon L, Saco A, Rakislova N, Ordi J, Torné A. Colposcopic impression has a key role in the estimation of the risk of hsil/cin3. Cancers. 2021;13(6):1–12.
24.
Ghosh I, Mittal S, Banerjee D, Singh P, Dasgupta S, Chatterjee S, Biswas J, Panda C, Basu P. Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program. Aust N Z J Obstet Gynaecol. 2014;54(6):570–5.PubMedCrossRef
25.
Li J, Wang W, Yang P, Chen J, Dai Q, Hua P, Liu D. Analysis of the agreement between colposcopic impression and histopathological diagnosis of cervical biopsy in a single tertiary center of Chengdu. Arch Gynecol Obstet. 2021;304(4):1033–41.PubMedCrossRef
26.
Liu F, Zhang Y, Xia X, Han J, Hu D. Diagnostic value of different colposcopy evaluation methods for high-grade squamous intraepithelial lesions and cervical cancer. Eur J Gynaecol Oncol. 2021;42(3):463–9.CrossRef
27.
Ruan Y, Liu M, Guo J, Zhao J, Niu S, Li F. Evaluation of the accuracy of colposcopy in detecting high-grade squamous intraepithelial lesion and cervical cancer. Arch Gynecol Obstet. 2020;302(6):1529–38.PubMedCrossRef
28.
Spinillo A, Gardella B, Chiesa A, Cesari S, Alberizzi P, Silini EM. Diagnostic accuracy of colposcopy in relation to human papillomavirus genotypes and multiple infection. Gynecol Oncol. 2014;134(3):527–33.PubMedCrossRef
29.
Wei B, Zhang B, Xue P, Seery S, Wang J, Li Q, Jiang Y, Qiao Y. Improving colposcopic accuracy for cervical precancer detection: a retrospective multicenter study in China. BMC Cancer. 2022;22(1):388.PubMedPubMedCentralCrossRef
30.
Zhao Y, Song Y, Zhao F, Zhang W, Li L, Chen F, Chen W, Pan Q, Shen G, Qiao Y. Value of 4-quadrant biopsies under colposcopy for detecting precancerous lesions in cervical cancer screening. Zhonghua Zhong Liu Za Zhi. 2015;37(11):875–9.PubMed
31.
Liu BB, Zhu YL, Zhang WH, Zhang H, Wang XX, Yu XJ, Zhang P, Zhang J, Wang L, Fang SW, et al. Clinical analysis of 128 cases of cervical lesion diagnosed by multi-point biopsy of colposcopy and endocervical curettage. Zhonghua Zhong Liu Za Zhi. 2018;40(7):539–42.PubMed
32.
Stuebs FA, Dietl AK, Behrens A, Adler W, Geppert C, Hartmann A, Knöll A, Beckmann MW, Mehlhorn G, Schulmeyer CE, et al. Concordance Rate of Colposcopy in Detecting Cervical Intraepithelial Lesions. Diagnostics (Basel). 2022;12(10):2436.PubMedCrossRef
33.
Zhang D, Song J, Zhang X, Bi H. The value of p16(INK4a) immunostaining for high-grade squamous intraepithelial lesions in human papillomavirus-negative patients. Bmc Womens Health. 2022;22(1):138.PubMedPubMedCentralCrossRef
34.
Maffini CF, Collaco LM, Martins Sebastiao AP, Zanine RM. Colposcopic Findings and Diagnosis in Low-Income Brazilian Women with ASC-H pap Smear Results. Revista Brasileira De Ginecologia E Obstetricia. 2022;44(02):178–86.PubMedCrossRef
35.
Brown BH, Tidy JA. The diagnostic accuracy of colposcopy - A review of research methodology and impact on the outcomes of quality assurance. Eur J Obstet Gynecol Reprod Biol. 2019;240:182–6.PubMedCrossRef
36.
Underwood M, Arbyn M, Parry-Smith W, De Bellis-Ayres S, Todd R, Redman CW, Moss EL. Accuracy of colposcopy-directed punch biopsies: a systematic review and meta-analysis. BJOG. 2012;119(11):1293–301.PubMedCrossRef
37.
Hong DG, Seong WJ, Kim SY, Lee YS, Cho YL. Prediction of high-grade squamous intraepithelial lesions using the modified Reid index. Int J Clin Oncol. 2010;15(1):65–9.PubMedCrossRef
38.
Tatiyachonwiphut M, Jaishuen A, Sangkarat S, Laiwejpithaya S, Wongtiraporn W, Inthasorn P, Viriyapak B, Warnnissorn M. Agreement between colposcopic diagnosis and cervical pathology: Siriraj hospital experience. Asian Pac J Cancer Prev. 2014;15(1):423–6.PubMedCrossRef
39.
Durdi GS, Sherigar BY, Dalal AM, Desai BR, Malur PR. Correlation of colposcopy using Reid colposcopic index with histopathology- a prospective study. J Turk Ger Gynecol Assoc. 2009;10(4):205–7.PubMedPubMedCentral
40.
Gage JC, Hanson VW, Abbey K, Dippery S, Gardner S, Kubota J, Schiffman M, Solomon D, Jeronimo J. Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol. 2006;108(2):264–72.PubMedCrossRef
41.
Sankaranarayanan R, Gaffikin L, Jacob M, Sellors J, Robles S. A critical assessment of screening methods for cervical neoplasia. Int J Gynaecol Obstet. 2005;89(Suppl 2):S4-s12.PubMedCrossRef
42.
Li Y, Duan X, Sui L, Xu F, Xu S, Zhang H, Xu C. Closer to a Uniform Language in Colposcopy: Study on the Potential Application of 2011 International Federation for Cervical Pathology and Colposcopy Terminology in Clinical Practice. Biomed Res Int. 2017;2017:8984516.PubMedPubMedCentral
43.
Louwers JA, Kocken M, ter Harmsel WA, Verheijen RH. Digital colposcopy: ready for use? An overview of literature Bjog. 2009;116(2):220–9.PubMed
44.
Bekkers RL, van de Nieuwenhof HP, Neesham DE, Hendriks JH, Tan J, Quinn MA. Does experience in colposcopy improve identification of high grade abnormalities? Eur J Obstet Gynecol Reprod Biol. 2008;141(1):75–8.PubMedCrossRef
45.
Parra S, Oden M, Schmeler K, Richards-Kortum R. Low-Cost Instructional Apparatus to Improve Training for Cervical Cancer Screening and Prevention. Obstet Gynecol. 2019;133(3):559–67.PubMedPubMedCentralCrossRef
46.
Jeronimo J, Long LR, Neve L, Michael B, Antani S, Schiffman M. Digital tools for collecting data from cervigrams for research and training in colposcopy. J Low Genit Tract Dis. 2006;10(1):16–25.PubMedCrossRef
47.
Xue P, Wang J, Qin D, Yan H, Qu Y, Seery S, Jiang Y, Qiao Y. Deep learning in image-based breast and cervical cancer detection: a systematic review and meta-analysis. NPJ Digit Med. 2022;5(1):19.PubMedPubMedCentralCrossRef
48.
49.
Fokom-Domgue J, Combescure C, Fokom-Defo V, Tebeu PM, Vassilakos P, Kengne AP, Petignat P. Performance of alternative strategies for primary cervical cancer screening in sub-Saharan Africa: systematic review and meta-analysis of diagnostic test accuracy studies. BMJ. 2015;351:h3084.PubMedPubMedCentralCrossRef
50.
Fokom-Domgue J, Vassilakos P, Petignat P. Is screen-and-treat approach suited for screening and management of precancerous cervical lesions in Sub-Saharan Africa? Prev Med. 2014;65:138–40.PubMedCrossRef
Metadata
Title
Colposcopic accuracy in diagnosing squamous intraepithelial lesions: a systematic review and meta-analysis of the International Federation of Cervical Pathology and Colposcopy 2011 terminology
Authors
Dongxu Qin
Anying Bai
Peng Xue
Samuel Seery
Jiaxu Wang
Maria Jose Gonzalez Mendez
Qing Li
Yu Jiang
Youlin Qiao
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2023
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-023-10648-1

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