colposcopy random cervical biopsies endocervical curettage
DESCRIPTION
COLPOSCOPY RANDOM CERVICAL BIOPSIES ENDOCERVICAL CURETTAGE. [email protected] S.C.P.M.G.-Fontana. I. IV. II. III. - PowerPoint PPT PresentationTRANSCRIPT
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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
d of
CIN
3 o
r Can
cer p
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
