Endocervicoscopy: a new technique for the diagnostic work-up of cervical intraepithelial neoplasia allowing a tailored excisional therapy in young fertile women.
OBJECTIVE
To propose and validate endocervicoscopy, a new technique for patients with high-grade squamous intraepithelial lesion and unsatisfactory or negative colposcopy.


METHODS
Prospective trial.


METHODS
Department of Obstetrics, Gynaecology and Pathophysiology of Human Reproduction University of Naples Federico II.


METHODS
Ninety-five consecutive patients with repeatedly positive cervicovaginal cytology for high-grade squamous intraepithelial lesion and negative or unsatisfactory colposcopy.


METHODS
Endoscopic evaluation of the endocervical mucosa, performed with an office continuous-flow hysteroscope after application of acetic acid 5% (endocervicoscopy). Patients diagnosed with abnormal cervical findings (group A) underwent targeted biopsies of the visualized abnormalities. Negative patients at endocervicoscopy (group B) underwent blind curettage of the endocervix. Eventually, both groups underwent a cold knife conization.


METHODS
Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of endocervicoscopy plus targeted biopsy and curettage, compared with the reference test, represented by surgical specimen of cervical conization.


RESULTS
Endocervicoscopy plus targeted biopsy showed a sensitivity of 79%, a specificity of 100%, a diagnostic accuracy of 80%, a PPV of 99%, and a NPV of 51%. The volume of cone biopsy of patients from group A was significantly smaller than that of group B (3.03 ± 0.61 mL vs. group B: 4.07 ± 0.24 mL).


CONCLUSIONS
Endocervicoscopy appears to be a safe and effective office technique, improving the diagnostic work-up of cervical intraepithelial lesions. The precise localization of the lesions allows for the depth of cone excision to be tailored, thus leading to a more conservative treatment and preserving the future fertility of women.
Bifulco
Giuseppe
G
Department of Obstetric, Gynaecology and Pathophysiology of Human Reproduction, University of Naples Federico II, Naples, Italy.
Piccoli
Roberto
R
Lavitola
Giada
G
Di Spiezio Sardo
Attilio
A
Spinelli
Marialuigia
M
Cavallaro
Angelo
A
Nappi
Carmine
C
D000328:Adult; D001706:Biopsy / Q000379:methods; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005298:Fertility / Q000502:physiology; D013509:Gynecologic Surgical Procedures; D006801:Humans; D015907:Hysteroscopy / Q000379:methods*; D011237:Predictive Value of Tests; D011859:Radiography; D012680:Sensitivity and Specificity; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*