Knowledge of cytology results affects the performance of colposcopy: a crossover study

• Published in: BMC women's health Vol. 24; no. 1; p. 189
• Main Authors: Lalande, Eva, Clarke, Holly, Undurraga, Manuela, Nguyen, Vu Quoc Huy, Jaksic, Cyril, Goffin, Frederic, Arbyn, Marc, Jeronimo, Jose, Tille, Jean-Christophe, Saiji, Essia, Vassilakos, Pierre, Petignat, Patrick
• Format: Journal Article Web Resource
• Language: English
• Published: England BioMed Central Ltd 21.03.2024; BioMed Central; BMC
• Subjects: Acetic acid; Acids; Biopsy; Cellular biology; Cervical cancer; Cervical intraepithelial neoplasia (CIN); Cervix; Colposcopy; Colposcopy - methods; Cross-Over Studies; Cytodiagnosis; Cytology; Diagnosis; Dosage and administration; Female; Histology; Histopathology; Human health sciences; Human papillomavirus; Humans; Knowledge; Lesions; Medical diagnosis; Médecine de la reproduction (Gynécologie, andrologie, obstétrique); Organic acids; Papillomaviridae; Papillomavirus Infections - diagnosis; Patient outcomes; Patients; Prevention; Reproductive medicine (gynecology, andrology, obstetrics); Risk factors; Sciences de la santé humaine; Statistical analysis; Statistical methods; Uterine Cervical Dysplasia - diagnosis; Uterine Cervical Neoplasms - diagnosis; Uterine Cervical Neoplasms - pathology; Vaginal Smears - methods; Womens health; Switzerland; United States > US; Colposcopy; Diagnosis; Cervical intraepithelial neoplasia (CIN); Cross-over studies; Cytology
• ISSN: 1472-6874; 1472-6874
• DOI: 10.1186/s12905-024-03025-y

To determine whether knowledge of cytology affects the colposcopist's diagnostic accuracy in the identification of cervical intraepithelial neoplasia grade 2 and worse (≥ CIN2). In this cross-over study, healthcare professionals interpreted colposcopy images from 80 patient cases with known histological diagnoses. For each case, 2 images taken with a colposcope were provided (native and after acetic acid application). Inclusion criteria consisted of women with a transformation zone type 1 or 2, who had both a cytological and histological diagnosis. Cases were distributed across two online surveys, one including and one omitting the cytology. A wash-out period of six weeks between surveys was implemented. Colposcopists were asked to give their diagnosis for each case as < CIN2 or ≥ CIN2 on both assessments. Statistical analysis was conducted to compare the two interpretations. Knowledge of cytology significantly improved the sensitivity when interpreting colposcopic images, from 51.1% [95%CI: 39.3 to 62.8] to 63.7% [95%CI: 52.1 to 73.9] and improved the specificity from 63.5% [95%CI: 52.3 to 73.5] to 76.6% [95%CI: 67.2 to 84.0]. Sensitivity was higher by 38.6% when a high-grade cytology (ASC-H, HSIL, AGC) was communicated compared to a low-grade cytology (inflammation, ASC-US, LSIL). Specificity was higher by 31% when a low-grade cytology was communicated compared to a high-grade. Our data suggests that knowledge of cytology increases sensitivity and specificity for diagnosis of ≥ CIN2 lesions at colposcopy. Association between cytology and histology may have contributed to the findings.