Punch biopsy guided by both colposcopy and HR-HPV status is more efficient for identification of immediate high-grade squamous intraepithelial lesion or worse among HPV-infected women with atypical squamous cells of undetermined significance.
OBJECTIVE
To investigate the accuracy of colposcopy for diagnosing high-grade squamous intraepithelial lesion (HSIL) or worse (HSIL+) in human papillomavirus (HPV)-infected patients with atypical squamous cells of undetermined significance (ASCUS) cytology, and determine whether genotyping and viral load quantitation can be useful for detecting immediate HSIL+ risk in these patients.


METHODS
This study included 620 cases with ASCUS and positive for high-risk (HR)-HPV within 1 month before or after cervical cytology at Qilu Hospital between February 2013 and February 2014. Based on the colposcopic impression, lesion-targeted punch biopsy, endocervical curettage biopsy or random cervical punch biopsy in four quadrants was performed on these patients within 1 month. The accuracy of colposcopy for diagnosing HSIL+ was evaluated through comparison with the biopsy results. HR-HPV status determined by Hybrid Capture 2 or HPV genotyping was analysed retrospectively as a possible predictor of HSIL+.


RESULTS
Agreement between colposcopic impression and cervical pathology was matched perfectly in 89.2% of cases (553/620), and the strength of agreement with the κ statistic was 0.698 (p<0.001). Colposcopy had high specificity (96.9%) but low sensitivity for detecting HSIL+ (67.5%). The risk of HSIL+ was significantly higher in patients with HPV-16 infection (52.3%) than in patients infected with other types of HPV (17.9%, p<0.001). HSIL+ and virus load was correlated at cut-offs (CO) of 50 relative light units (RLU)/CO and 100 RLU/CO (p=0.024 and 0.044, respectively). If considering HPV16 infection or high virus load (at 50 RLU/CO) as a diagnostic standard of HSIL+ when colposcopic impression was negative, sensitivity was improved to 74.7% and 81.0%, respectively.


CONCLUSIONS
Good agreement was found between colposcopic and pathologic diagnosis. HR-HPV genotyping or virus load is relevant to the detection of HSIL+ among HPV-infected patients with ASCUS cytology. In these patients, biopsies considering HPV-16 infection or virus load ≥50 RLU/CO may be helpful for increasing the HSIL+ detection rate.
Qilu Hospital, Shandong University, Jinan, Shandong, China; The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
Z
Z
Ding
The Second People's Hospital of Liao Cheng, Liao Cheng, Shandong, China.
Y
Y
Li
The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
A
A
Chen
Qingdao Tumour Hospital, Qingdao, Shandong, China.
M
M
Song
Qilu Hospital, Shandong University, Jinan, Shandong, China. Electronic address: yuetutu1979@163.com.
Y
Y
Zhang
D000328:Adult; D065309:Atypical Squamous Cells of the Cervix / Q000473:pathology / Q000821:virology; D001706:Biopsy; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000473:pathology / Q000821:virology; D002681:China / Q000453:epidemiology; D003127:Colposcopy; D003937:Diagnosis, Differential; D055088:Early Detection of Cancer / Q000379:methods*; D057286:Electronic Health Records; D005260:Female; D006305:Health Status Indicators; D006785:Hospitals, University; D061809:Human Papillomavirus DNA Tests; D006801:Humans; D061705:Image-Guided Biopsy; D008875:Middle Aged; D060787:Neoplasm Grading; D027383:Papillomaviridae / Q000145:classification / Q000302:isolation & purification*; D030361:Papillomavirus Infections / Q000150:complications* / Q000453:epidemiology / Q000821:virology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology / Q000821:virology; D019562:Viral Load
Atypical squamous cells of undetermined significance; Colposcopy; HPV genotype; HPV viral load; High-grade squamous intraepithelial lesion