Xiaodan Zhang1, Yuya Dou2, Mateng Wang3, Yang Li4, Fenfen Wang4, Xing Xie4, Xinyu Wang5. 1. Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China; Ningbo No 2 hospital, Xibei Rd#41, Ningbo, Zhejiang 315000, China. 2. Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China; College of Life Science, Southwest University, Gaotanyanzheng Rd#30,Chongqing, 400038, China. 3. Ningbo Yinzhou No 2 hospital,Qianhe Rd#1, Ningbo, Zhejiang 315192, China. 4. Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China; Key Laboratory of Women's Reproductive Health of Zhejiang Province, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China. 5. Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China; Key Laboratory of Women's Reproductive Health of Zhejiang Province, Xueshi Rd#2, Hangzhou, Zhejiang 310006, China. Electronic address: wangxy@zju.edu.cn.
Abstract
OBJECTIVE: Clinically, an unbefitting management for high grade squamous intraepithelial lesion (HSIL) may result from an inaccurate diagnosis by colposcopy bioposy.The study aimed to assess the diagnostic accuracy by colposcopic biopsy and evaluate the associated factors in diagnosing HSIL. STUDY DESIGN: Clinical data of 1901 women who were primarily diagnosed as HSIL by colposcopic biopsy and then underwent definitive surgery within six-month interval in Women's Hospital, School of Medicine, Zhejiang University during 2009-2015, were retrospectively collected. The diagnostic accuracy of HSIL by colposcopic biopsy was assessed and the correlations between diagnostic accuracy and clinic-pathological variables were calculated by univariate and multivariate analysis using the pathological diagnosis by definitive surgery as a reference standard. RESULTS: The accordance rate of HSIL diagnosis between colposcopic biopsy and definitive surgery was 80.6%, with an under-diagnosis rate of 5.8% and an over-diagnosis rate of 13.6%. Cytology≤low grade squamous intraepithelial lesion(LSIL) (OR:1.599;95%CI:1.185-2.160), colposcopy≤LSIL (OR:2.083;95%CI:1.537-2.824), endocervical curettage (ECC)≤LSIL(OR:2.813;95%CI:2.051-3.857), and lesion without gland involved (OR:1.751;95%CI:1.299-2.361) were independent risk factors for over-diagnosis of HSIL. Women with≥3 risk factors had a 5.078-flod higher risk for over-diagnosis of HSIL compared to those with≤1 risk factor. Irregular vaginal bleeding (OR:2.570,95%CI:1.668-3.960), colposcopy=HSIL (OR:1.699,95%CI:1.022-2.824), ECC=HSIL (OR:2.666, 95%CI:1.728-4.113), and multiple biopsies (OR:1.818, 95%CI:1.153-2.868) were independent risk factors for under-diagnosis of HSIL. Women with ≥3 risk factors had a 5.710-flod higher risk for under-diagnosis of HSIL compared to those with ≤1 risk factor. CONCLUSIONS: The diagnostic accuracy of HSIL by colposcopic biopsy is about 80% and associated with some factors including symptom, cytology result, colposcopy diagnosis, and biopsy number. These variables may be predictors for over-diagnosis or under-diagnosis of HSIL by colposcopic biopsy.
OBJECTIVE: Clinically, an unbefitting management for high grade squamous intraepithelial lesion (HSIL) may result from an inaccurate diagnosis by colposcopy bioposy.The study aimed to assess the diagnostic accuracy by colposcopic biopsy and evaluate the associated factors in diagnosing HSIL. STUDY DESIGN: Clinical data of 1901 women who were primarily diagnosed as HSIL by colposcopic biopsy and then underwent definitive surgery within six-month interval in Women's Hospital, School of Medicine, Zhejiang University during 2009-2015, were retrospectively collected. The diagnostic accuracy of HSIL by colposcopic biopsy was assessed and the correlations between diagnostic accuracy and clinic-pathological variables were calculated by univariate and multivariate analysis using the pathological diagnosis by definitive surgery as a reference standard. RESULTS: The accordance rate of HSIL diagnosis between colposcopic biopsy and definitive surgery was 80.6%, with an under-diagnosis rate of 5.8% and an over-diagnosis rate of 13.6%. Cytology≤low grade squamous intraepithelial lesion(LSIL) (OR:1.599;95%CI:1.185-2.160), colposcopy≤LSIL (OR:2.083;95%CI:1.537-2.824), endocervical curettage (ECC)≤LSIL(OR:2.813;95%CI:2.051-3.857), and lesion without gland involved (OR:1.751;95%CI:1.299-2.361) were independent risk factors for over-diagnosis of HSIL. Women with≥3 risk factors had a 5.078-flod higher risk for over-diagnosis of HSIL compared to those with≤1 risk factor. Irregular vaginal bleeding (OR:2.570,95%CI:1.668-3.960), colposcopy=HSIL (OR:1.699,95%CI:1.022-2.824), ECC=HSIL (OR:2.666, 95%CI:1.728-4.113), and multiple biopsies (OR:1.818, 95%CI:1.153-2.868) were independent risk factors for under-diagnosis of HSIL. Women with ≥3 risk factors had a 5.710-flod higher risk for under-diagnosis of HSIL compared to those with ≤1 risk factor. CONCLUSIONS: The diagnostic accuracy of HSIL by colposcopic biopsy is about 80% and associated with some factors including symptom, cytology result, colposcopy diagnosis, and biopsy number. These variables may be predictors for over-diagnosis or under-diagnosis of HSIL by colposcopic biopsy.