The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia.
The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia.
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DOI：
10.1097/lgt.0b013e31819308d4
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发表时间：
2009-07
影响因子：
3.7
通讯作者：
National Institutes of Health/American Society for Colposcopy and Cervical Pathology Research Group
中科院分区：
文献类型：
--
作者：
Massad LS;Jeronimo J;Katki HA;Schiffman M;National Institutes of Health/American Society for Colposcopy and Cervical Pathology Research Group
To relate aspects of online colposcopic image assessment to the diagnosis of grades 2 and 3 cervical intraepithelial neoplasia (CIN2+). To simulate colposcopic assessment, digitized cervical images were obtained at enrollment after acetic acid application from 919 women referred for equivocal or minor cytologic abnormalities into the ASCUS-LSIL Triage Study. For each, two randomly assigned evaluators from a pool of 20 colposcopists assessed images using a standardized tool on-line. We calculated the accuracy of these assessments for predicting histologic CIN2+ over the two years of study. For validation, a subset of on-line results was compared to same-day enrollment colposcopic assessments. Identifying any acetowhite lesion in images yielded high sensitivity: 93% of women with CIN2+ had at least one acetowhite lesion. However, 74% of women without CIN2+ also had acetowhitening, regardless of human papillomavirus (HPV) status. The sensitivity for CIN2+ of an on-line colpophotographic assessment of high grade disease was 39%. The sensitivity for CIN2+ of a high grade diagnosis by Reid Index scoring was 30%, and individual Reid Index component scores had similar levels of sensitivity and specificity. The performance of on-line assessment was not meaningfully different from that of same-day enrollment colposcopy, suggesting that these approaches have similar utility. Finding acetowhite lesions identifies women with CIN2+, but using subtler colposcopic characteristics to grade lesions is insensitive. All acetowhite lesions should be assessed with biopsy to maximize sensitivity of colposcopic diagnosis with good specificity.
