Agreement between colposcopic impression and histological diagnosis among human papillomavirus type 16-positive women: a clinical trial using dynamic spectral imaging colposcopy.
OBJECTIVE
To investigate the agreement between conventional colposcopic impression, dynamic spectral imaging (DSI) colposcopy and histology, for human papillomavirus type 16-positive (HPV16(+)) and non-16 high-risk (hr) HPV(+) women.


METHODS
Prospective, comparative, multicentre clinical trial.


METHODS
Three colposcopy clinics in the Netherlands.


METHODS
Women (n = 177) aged 18 years or over with an intact cervix, referred for colposcopy.


METHODS
The colposcopist graded the lesion by using the DSI colposcope as a regular video colposcope. Subsequently the DSI impression was displayed and biopsies were taken from all abnormal areas as well as from a random (normal) site. A cervical smear was taken for HPV typing.


METHODS
Histologically confirmed high-grade cervical intraepithelial neoplasia or cancer (CIN2(+)), positive for HPV16 or for any other hrHPV type.


RESULTS
The DSI colposcope identified more CIN2(+) cervical lesions among HPV16(+) women than in non-16 hrHPV(+) women (P = 0.032 regardless of final histology and P = 0.009 among women with CIN2(+)). Consequently, the sensitivity of the DSI colposcope for detecting CIN2(+) lesions was higher in HPV16(+) women than in non-16 hrHPV(+) women (97% versus 74%, P = 0.009). No such differences were seen for the colposcopist impression. In addition, mainly smaller cervical lesions are missed by the colposcopist.


CONCLUSIONS
The sensitivity of DSI colposcopy for CIN2(+) is higher in HPV16(+) than in non-16 hrHPV(+) women. Furthermore, regardless of HPV16 status, the sensitivity of DSI for CIN2(+) is higher than that of the colposcopist, probably because colposcopists tend to miss smaller cervical lesions.
Division of Woman and Baby, Gynaecological Oncology, University Medical Center Utrecht, Utrecht, The Netherlands. a.zaal@umcutrecht.nl
A
A
Zaal
J A
JA
Louwers
J
J
Berkhof
M
M
Kocken
W A
WA
Ter Harmsel
G C M
GC
Graziosi
J W M
JW
Spruijt
C
C
Balas
E
E
Papagiannakis
P J F
PJ
Snijders
C J L M
CJ
Meijer
F J
FJ
van Kemenade
R H M
RH
Verheijen
D000293:Adolescent; D000328:Adult; D020681:Colposcopes / Q000592:standards; D003127:Colposcopy / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D005260:Female; D052162:Human papillomavirus 16; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000473:pathology* / Q000821:virology; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology; D014626:Vaginal Smears; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology