title: Diagnostic accuracy of colposcopy in relation to human papillomavirus genotypes and multiple infection.
abstract: OBJECTIVE
  The aim of this study is to evaluate the diagnostic accuracy of colposcopy for cervical intraepithelial neoplasia grade 3 or worse (CIN3+) in relation to the detection of human papillomavirus (HPV) type 16 and multiple HPV infection.
  
  
  METHODS
  A cohort study of 2526 subjects attending a colposcopic service because of cytological abnormalities. HPV genotypes were identified using the INNO-LIPA genotyping system.
  
  
  RESULTS
  The final colposcopic/pathological diagnoses were as follows: 1282 (50.8%) negative, 709 (28.1%) CIN1, 169 (6.7%) CIN2, 318 (12.6%) CIN3 and 48 (1.9%) invasive cervical cancer, respectively. Among women with ASCUS/LSIL, assuming any colposcopic abnormality as a cut-off, there were no significant differences in the sensitivities (83.8%, 95% CI=76-89.6 as compared to 84.1%, 95% CI=73.2-91.1, p=0.9) and ROC curves (0.61, 95% CI=0.58-0.65 as compared to 0.59, 95% CI=0.54-0.64, p=0.5) in the detection of CIN3+ lesions between subjects with single and multiple high-risk infection, and between subjects infected by HPV16 (83.1%, 95% CI=73.7-89.7, ROC=0.59, 95% CI=0.54-063) or other high-risk HPVs (84.7%, 95% CI=75.6-90.8, ROC=0.62, 95% CI=0.58-0.66, p=0.8 and p=0.6 compared to HPV16). After correction for confounders, the odds ratios of CIN3+ associated with any abnormal colposcopic findings were 2.47 (95%CI=1.44-4.23, p=0.001) among HPV16 positive, 3.34 (95% CI=2.16-5.42, p<0.001) among other high-risk HPVs and 1.3 (95% CI=0.72-2.48, p=0.36) among subjects with negative/low-risk HPVs.
  
  
  CONCLUSIONS
  In routine clinical practice, multiple infection or HPV16 positivity did not affect colposcopic accuracy in the diagnosis of CIN3+ lesions. The sensitivity of colposcopy was poor among subjects who were uninfected or infected by low-risk HPV genotypes.
authors.affiliation: Department of Obstetrics and Gynecology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Italy. Electronic address: spinillo@smatteo.pv.it.
authors.forename: Arsenio
authors.initials: A
authors.lastname: Spinillo
authors.affiliation: Department of Obstetrics and Gynecology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gardella
authors.affiliation: Department of Obstetrics and Gynecology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Chiesa
authors.affiliation: Department of Pathology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Cesari
authors.affiliation: Department of Pathology, University of Pavia, IRCCS Fondazione Policlinico San Matteo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Alberizzi
authors.affiliation: Department of Biomedical, Biotechnological and Translational Sciences, Unit of Surgical Pathology and Center for Molecular and Translational Oncology (COMT), University of Parma, Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Silini
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003127:Colposcopy; D005260:Female; D005838:Genotype; D052162:Human papillomavirus 16 / Q000235:genetics*; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000473:pathology*; D015203:Reproducibility of Results; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000821:virology*; D055815:Young Adult; D002578:Uterine Cervical Dysplasia / Q000473:pathology* / Q000821:virology*
keywords: Cervical intraepithelial neoplasia; Cervicall cancer; Colposcopy; Human papillomavirus