colposcopy random cervical biopsies endocervical curettage

COLPOSCOPYRANDOM CERVICAL BIOPSIESENDOCERVICAL CURETTAGE

Robert.G.Pretorius@kp.org

S.C.P.M.G.-Fontana

I

II

IV

III

Pretorius RG et. al. JLGTD 2011;15:180-8

PROPORTION OF CIN 3 OR CANCER (CIN 3+) DIAGNOSED BY COLPOSCOPICALLY DIRECTED

BIOPSY OF A VISIBLE LESION, ‘RANDOM’ BIOPSY FROM A CERVICAL QUADRANT WITHOUT A LESION,

OR SOLELY BY ECC OF CIN 3+

Colposcopically Directed

‘Random’ Solely ECC3+

63.5% (141/222)

25.7% (57/222)

10.8% (24/222)

1p for trend <.001 from Pretorius RG et. al. JLGTD 2011;15:180-8

SENSITIVITY FOR CIN 3 OR CANCER (CIN 3+) OF BIOPSY OF CERVICAL QUADRANTS WITH COLPOSCOPIC

IMPRESSION OF HPV, CIN, OR CANCER AS A FUNCTION OF THE NUMBER OF CERVICAL QUADRANTS WITH CIN

3+ (0 quadrants is diagnosis solely by positive ECC)

  0 Quadrant with CIN 3+

1 Quadrant with CIN 3+

2 Quadrant with CIN 3+

3 Quadrant with CIN 3+

4 Quadrant with CIN 3+

Sensitivity Colposcopy

0% (0/24)

58.5%1

(62/106) 81.1%1

(43/53) 84.2%1

(16/19) 100%1

(20/20)

Yang B et. al. Gynecol Oncol 2008;110:32-6

AVERAGE EPITHELIAL THICKNESS (MICRONS) BY COLPOSCOPIC IMPRESSION AND HISTOLOGY

(SELECTED REVIEW OF SPOCCS I SLIDES)HISTOLOGY COLPO

IMP NORMAL

COLPO IMPLOW

COLPO IMPHIGH

COLPO IMPCANCER

NORMAL 378 370 482CIN 1 355 346 418 310CIN 2 185 258 334 346CIN 3 181 230 372 426

Pretorius RG et. al. JLGTD 2011;15:180-8

YIELD OF CIN 3 OR CANCER PER COLPOSCOPY

0

0.05

0.1

0.15

0.2

0.25

0 1 2 3 4 5 6

Biopsies in addition to colpo-directed biopsy

Yiel

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CIN

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er c

olpo

scop

y

Doc 1, r=.959, p=.0025

Doc 2, r=.921, p=.009

Doc 3, r=.958, p=.003

Doc 4, r=.995, p<.001

Doc 5, r=.645, p=.17

Doc 6, r=.983, p<.001

Doc 7, r=.943, p=.005

COMPARISON OF CHINA COLPOSCOPY CLINIC (in which eligible women were 35 to 50 years of age, had colposcopy for cytology of

Cancer, HSIL, AGUS, LSIL, or ASC-US with positive HR-HPV and were diagnosed with CIN 3+ only by cervical biopsy and/or ECC showing

CIN 3+) WITH A SIMILAR MATCHED SERIES FROM S.C.P.M.G.-FONTANA 2007-2009

  China series S.C.P.M.G.-Fontana

Prevalence CIN 3+ 2.3% (222/10,425) 0.2% (71/42,803)

Prevalence Cancer 0.2% (21/10,425) 0.03% (13/42,803)

% cervical CIN 3+ with negative colposcopy

22.7%1 (45/198) 23.1%1 (15/65)

% CIN 3+ diagnosed by ECC of CIN 3+

10.8%2 (24/222) 8.5%2 (6/71)

Median age (years) 40 43

122.7% vs. 23.1%, p=.95, 210.8% vs. 8.5%, p=.57, Pretorius RG et. al. JLGTD2012;16:333-8

Pretorius RG et. al. JLGTD 2012;16:333-8

PROPORTION OF CIN 3 OR CANCER (CIN 3+) IN S.C.P.M.G.-FONTANA COLPOSCOPY CLINIC 2007-2009

DIAGNOSED SOLELY BY ECC of CIN 2+ AGE (Years) CIN 3+ SOLELY BY ECC 16-24 0.0% (0/32) 25-34 6.6% (7/105) 35-44 7.5% (7/93) 45-54 22.6% (7/31) ≥55 27.7% (5/18) Total 9.3% (26/279)

‘RANDOM’ BIOPSIES IN CERVICAL QUADRANTS WITHOUT VISIBLE LESIONS

AND ECC SHOULD BE DONE AT COLPOSCOPY FOR EVALUATION OF

ABNORMAL CERVICAL CANCER SCREENING TESTS

THE ECC MAY BE OMITTED ON WOMEN UNDER AGE 25 YEARS

Pretorius RG et. al. JLGTD 2012;16:333-8

THANK YOU FOR YOUR ATTENTION

Robert.G.Pretorius@kp.org