Colposcopic Findings and Diagnosis in Low-Income Brazilian Women with ASC-H pap Smear Results

Maffini, Cibele Feroldi; Collaço, Luiz Martins; Sebastião, Ana Paula Martins; Zanine, Rita Maira

doi:10.1055/s-0042-1742289

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Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 44 (02) • Feb 2022 • https://doi.org/10.1055/s-0042-1742289 copy

Colposcopic Findings and Diagnosis in Low-Income Brazilian Women with ASC-H pap Smear Results

Achados colposcópicos e diagnóstico em mulheres brasileiras de baixa renda com resultado de exame citopatológico ASC-H

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To determine the accuracy of colposcopy findings in diagnosing cervical intraepithelial neoplasia (CIN) in women with an atypical squamous cells, cannot exclude high-grade squamous intraepithelial lesion (ASC-H) pap smear result and analyze whether the prevalence of HSIL and cancer correlates with sociodemographic risk factors and specific colposcopic findings.

Methods

Colposcopic findings and sociodemographic risk factors were analyzed as possible predictors of a CIN 2 or worse diagnosis in women with an ASC-H pap smear result.

Results

Accuracy of the colposcopic impression was 92%, sensitivity was 91.6%, and specificity was 93.1%, with a positive predictive value of 96.4% and negative predictive value of 84.3%. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. Identification of major colposcopic findings, dense acetowhite epithelium, coarse mosaicism, and punctuation correlated significantly with CIN 2 or worse.

Conclusion

Colposcopy performed by an experienced examiner can accurately differentiate patients with CIN 1 or less from patients with CIN 2 or worse. Diagnosis of CIN 2 or worse was more frequent in patients with a previous history of cervical dysplasia and pre-menopausal patients. The degree of acetowhite changes was the best colposcopic feature to predict CIN2 or worse.

Keywords:
colposcopy; cervical intraepithelial neoplasia; cervical cancer; ASC-H; cervix uteri

Characteristic	n	(%)
Age
Median	36	N/A
Range	21 to 84	N/A
Lifetime number of sexual partners
Median	2	N/A
Range	1 to 30	N/A
Menopause
Yes	23	(21.7%)
No	83	(78.3%)
Tobacco smoking
Yes	36	(34.0%)
No	70	(66.0%)
Coinfection with others sexually transmitted agents and HIV
Yes	17	(16.0%)
No	85	(80.2%)
HIV	4	(38%)
Previous history of HSIL
Yes	21	(19.8%)
No	85	(80.2%)

	CIN 1 or less			CIN 2 or worse		Non-attendance	P-value ^┼ ┼ comparing the incidence of CIN2/3and cancer between the groups with minor or negative versus major colposcopic impression. n, number of women in each category.
Colposcopic Impression/Transformation Zone	Negative Clinical follow-up	LLETZ histopathologic results
Colposcopic Impression/Transformation Zone	Negative Clinical follow-up	Negative	CIN 1	CIN2/3	Cancer
Major (grade 2) (n = 65)	0 (0.0)	2 (3.1)	2 (3.1)	53 (82.2)	7 (10.9)	1	< 0.001^* * statistically significant.
TZ1 (n = 36)	0 (0.0)	1 (2.8)	1 (2.8)	31 (88.6)	2 (5.7)	1
TZ2 (n = 14)	0 (0.0)	1 (7.1)	0 (0.0)	12 (85.7)	1 (7.1)	0
TZ3 (n = 15)	0 (0.0)	0 (0.0)	1 (6.6)	10 (66.6)	4 (26.6)	0
Minor (Grade 1) (n = 12)	6 (54.5)	0 (0.0)	3 (27.3)	2 (18.2)	0 (0.0)	1	< 0.001^* * statistically significant.
TZ1 (n = 9)	5 (62.5)	0 (0.0)	2 (25.0)	1 (12.5)	0 (0.0)	1
TZ2 (n = 1)	0 (0.0)	0 (0.0)	0 (0.0)	1 (100.0)	0 (0.0)	0
TZ3 (n = 2)	1 (50.0)	0 (0.0)	1 (50.0)	0 (0.0)	0 (0.0)	0
Negative (n = 29)	18 (66.7)	4 (14.8)	2 (7.4)	2 (7.4)	1 (3.7)	2
TZ1 (n = 6)	6 (100.0)	0 (0.0)	0 (0.0)	0 (0.0)	0 (0.0)	0
TZ2 (n = 4)	2 (66.6)	0 (0.0)	1 (33.3)	0 (0.0)	0 (0.0)	1
TZ3 (n = 29)	10 (55.5)	4 (22.2)	1 (5.5)	2 (11.1)	1 (5.5)	1
Total (n = 106)	24 (23.5)	6 (5.9)	7 (6.9)	57 (55.9)	8 (7.8)	4

Colposcopic findings	ENDPOINTS		P-value	Odds ratio
Colposcopic findings	CIN 1 or less	CIN 2 or worse	P-value	Odds ratio
Transformation zone
Types 1 and 2	18 (48.6%)	48 (73.8%)	0.011^* * Statistically significant; CIN, cervical intraepithelial neoplasia.	2.98 (1.27–6.96)
Type 3	19 (51.4%)	17 (26.2%)		2.98 (1.27–6.96)
Number of cervical quadrants covered by the lesion
0, 1, and 2	25 (67.5%)	49 (75.3%)	0.396	0.68 (0.27–1.65)
3 and 4	12 (32.4%)	16 (24.6%)	0.396	0.68 (0.27–1.65)
Acetowhite changes
Fine and absent	33 (89.2%)	8 (12.3%)	< 0.001^* * Statistically significant; CIN, cervical intraepithelial neoplasia.	58.78 (16.5–210.2)
Dense	4 (10.8%)	57 (87.7%)		58.78 (16.5–210.2)
Punctation
Dense	1 (2.7%)	22 (33.8%)	0.005^* * Statistically significant; CIN, cervical intraepithelial neoplasia.	18.42 (2.36–143.4)
Fine and absent	36 (97.3%)	43 (66.1%)		18.42 (2.36–143.4)
Mosaicism
Dense	1 (2.7%)	18 (28.1%)	0.011^* * Statistically significant; CIN, cervical intraepithelial neoplasia.	14.08 (1.79–110.5)
Fine and absent	36 (97.3%)	46 (71.9%)		14.08 (1.79–110.5)

	ENDPOINTS				P-value
	CIN 1 or less		CIN 2 or worse		P-value
Menopause
No	25	67.6%	54	83.1%	0.072
Yes	12	32.4%	11	16.9%	0.072
Tobacco smoking
No	27	73.0%	41	63.1%	0.308
Yes	10	27.0%	24	36.9%	0.308
Coinfection with other sexually transmitted agents and HIV
Coinfection with other sexually transmitted agents and HIV
No	31	83.8%	52	80.0%	0.999
Yes	5	13.5%	10	15.4%
HIV	1	2.7%	3	4.6%
Previous history of HSIL
No	26	70.3%	55	84.6%	0.085
Yes	11	29.7%	10	15.4%	0.085
Age
Average	41.54	SD 13.34	37.06	SD 12.42	0.091
Minimal	21		21
First quartile	32		28
Median	40		34
Third quartile	50		43
Maximal	74		84
Lifetime sexual partners
Average	3.92	SD 4.62	2.42	SD 2.42	0.817
Minimal	1		1
First quartile	2		3
Median	2		2.5
Third quartile	3		4
Maximal	20		10

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[1] Address for correspondence
Rita Maira Zanine, MD, PhD, Rua XV de Novembro, 1299, 80060-000, Centro, Curitiba, PR, Brazil (e-mail: ritazanine@yahoo.com.br).