Performance of Conventional Cytology and Colposcopy for the Diagnosis of Cervical Squamous and Glandular Neoplasias

Fachetti-Machado, Giselle; Figueiredo-Alves, Rosane Ribeiro; Moreira, Marise Amaral Rebouças

doi:10.1055/s-0038-1666995

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ginecologia e Obstetrícia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 40 (07) • July 2018 • https://doi.org/10.1055/s-0038-1666995 copy

Performance of Conventional Cytology and Colposcopy for the Diagnosis of Cervical Squamous and Glandular Neoplasias

Desempenho da citologia convencional e da colposcopia para o diagnóstico de neoplasias cervicais escamosas e glandulares

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To estimate the cytological and colposcopic performances for the diagnosis of cervical neoplasias.

Methods

Cross-sectional retrospective study with data from patients’ charts. The participants underwent colposcopy, guided biopsies, and excision when needed. The cytological and colposcopic categorization followed the Bethesda System and the international colposcopic terminologies. The cytology and colposcopy performances were evaluated by sensitivity (SE), specificity (SP), positive predictive value (PPV), and negative predictive value (NPV) analyses with 95% confidence interval (95% CI).

Results

From 1,571 participants, a total of 1,154 (73.4%) were diagnosed with cervical squamous intraepithelial neoplasia grade 2 or worse (CIN 2+), 114 (7.2%) with adenocarcinoma in situ or worse (AIS+), 615 (39.2%) presented atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion or worse (ASC-H+) cytology, and 934 (59.4%) presented major or suspicious for invasion colposcopic abnormalities. The SE, SP, PPV, and NPV of ASC-H+ for diagnoses of CIN 2+ and AIS+ were, respectively: 44% (95% CI: 41-47) and 72% (95% CI: 67-76), 79% (95% CI: 77-81) and 79% (95% CI: 75-83), 88% (95% CI: 87-90) and 55% (95% CI: 50-60), and 28% (95% CI: 26-31) and 88% (95% CI: 85-91). The SE, SP, PPV, and NPV of major or suspicious for invasion colposcopic abnormalities for diagnoses of CIN 2+ and AIS+were, respectively: 62% (95% CI: 60-65) and 86% (95% CI: 83-89), 59% (95% CI: 57-62) and 59% (95% CI: 55-64), 85% (95% CI: 83-87) and 44% (95% CI: 40-49), and 29% (95% CI: 27-32) and 92% (95% CI: 89-94).

Conclusion

The SE analyses results of ASC-H+ and major or suspicious for invasion colposcopic abnormalities were higher for diagnoses of glandular neoplasias. These results confirm the role of cytology in identifying women at risk who will have their final diagnoses settled by colposcopy and histology.

Keywords:
uterine cervical neoplasms; cervical intraepithelial neoplasia; squamous intraepithelial lesions of the cervix; adenocarcinoma in situ; papanicolaou test; colposcopy; sensitivity and specificity

Variables
Age	Years
Range	15–85
Mean (sd)	31.7 ± 10.8
Marital status^a 2;	n	%
Single	817	52.0
Married	752	47.9
Age at first intercourse^b 128;	Years
Range	9–47
Mean (sd)	18.9 ± 3.7
Lifetime sexual partners^c 192;	n	%
≤ 2	624	39.7
> 2	756	48.1
Full-term pregnancy^d 11;	n	%
≤ 1	1,107	70.5
> 1	453	28.8
Tobacco use^e 350.	n	%
Past and current smoker	148	9.4
Never smoker	1,073	68.3

Colposcopy referral	n	%
ASC-US/LSIL	796	50.7
ASC-H/HSIL	532	34.0
AGC	29	1.8
Adenocarcinoma in situ	22	1.4
Squamous cell carcinoma	16	1.0
Adenocarcinoma	16	1.0
Others^a cervical polip, cervical bleeding, unknown cytological finding, etc.	153	9.7
Colposcopy findings^b missing data:10.	n	%
Normal	9	0.5
Minor	618	39.3
Major	908	57.8
Suspicious for invasion	26	1.6
Final diagnosis	n	%
≤ CIN 1	303	19.3
CIN 2/CIN 3	1,124	71.6
Microinvasive squamous carcinoma	13	0.8
Squamous carcinoma	17	1.1
Adenocarcinoma in situ	78	5.0
Microinvasive adenocarcinoma	8	0.5
Adenocarcinoma	28	1.8

Cytological findings	Final diagnosis		Estimated performance (%) (95% CI)
ASC-H⁺	CIN 2⁺ (n= 1,376)
ASC-H⁺	Positive	Negative
Positive	474	63	Sensitivity	44 (41–47)
Positive	474	63	Specificity	79 (77–81)
Negative	603	236	PPV	88 (87–90)
Negative	603	236	NPV	28 (26–31)
ASC-H⁺	AIS⁺ (n= 408)		Estimated performance (%) (95% CI)
ASC-H⁺	Positive	Negative	Estimated performance (%) (95% CI)
Positive	78	63	Sensitivity	72 (67–76)
Positive	78	63	Specificity	79 (75–83)
Negative	31	236	PPV	55 (50–60)
Negative	31	236	NPV	88 (85–91)

Colposcopic report	Final diagnosis		Estimated performance (%) (95% CI)
Major or suspicious for invasion	CIN 2⁺ (n= 1,447)
Major or suspicious for invasion	Positive	Negative
Positive	713	123	Sensitivity	62 (60–65)
Positive	713	123	Specificity	59 (57–62)
Negative	432	179	PPV	85 (83–87)
Negative	432	179	NPV	29 (27–32)
Major or suspicious for invasion	AIS⁺ (n= 416)		Estimated performance (%) (95% CI)
Major or suspicious for invasion	Positive	Negative	Estimated performance (%) (95% CI)
Positive	98	123	Sensitivity	86 (83–89)
Positive	98	123	Specificity	59 (55–64)
Negative	16	179	PPV	44 (40–49)
Negative	16	179	NPV	92 (89–94)

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
E-mail: editorial.office@febrasgo.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Giselle Fachetti-Machado, MD, MSc, Universidade Federal de Goiás, Av. T4, esq. com T13, 1478, Salas 91B e 92B, Setor Bueno, Goiânia, GO, 74230-030, Brazil (e-mail: gfachettimachado@uol.com.br).