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COLPOSCOPY

COLPOSCOPY. Accuracy of Colposcopy Histopathologic basis for false negative and false positive colposcopic impressions Ramifications both clinical and scientific of using the iron (rather than gold) standard of colposcopically directed biopsy for ≥ CIN 2 P.O.I. 5-biopsy standard

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COLPOSCOPY

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  1. COLPOSCOPY Accuracy of Colposcopy Histopathologic basis for false negative and false positive colposcopic impressions Ramifications both clinical and scientific of using the iron (rather than gold) standard of colposcopically directed biopsy for ≥CIN 2 P.O.I. 5-biopsy standard Robert.G.Pretorius@kp.org

  2. INITIAL COLPOSCOPISTS’ AND REVIEWERS’ COLPOSCOPIC IMPRESSIONS IN ALTS Weighted kappa: 0.237 Ferris DG et. al. Am J Obstet Gynecol 2004;191:1934-41

  3. COLPOSCOPIC IMPRESSION OF WOMEN WITH ECTOCERVICAL CIN 2 OR WORSE SCPMG-FONTANA, 4/96 – 11/99 Pretorius RG et. al. J Reprod Med 2001;46:724-8

  4. I IV II III

  5. PROPORTION OF WOMEN WITH CIN 2, CIN 3, OR CANCER DIAGNOSED BY A COLPOSCOPICALLY DIRECTED BIOPSY 175.6% vs. 56.3%, Chi-Square=10.8, df=1, p<.001 283.7% vs. 57.9%, Chi-Square=10.1, df=1, p<.01 Pretorius RG et al. Int J Cancer 2007;121(10):2218-24

  6. MEASUREMENT OF THICKNESS AND DENSITY OF EPITHELIUM

  7. MEAN AVERAGE THICKNESS OF SQUAMOUS EPITHELIUM (µm) AS FUNCTIONS OF HISTOLOGY AND COLPOSCOPIC IMPESSION a184 vs. 250 vs. 352 vs. 410, p<.0001, GLMM b366 vs. 358 vs. 453 vs. 310, p=0.04, GLMM c387 vs. 290, p<.001, WRST Yang B et al. Gynecol Oncol 2008;110:32-6

  8. POOR CLINICAL DECISIONS FROM USING A COLPOSCOPIC DIRECTED BIOPSY ‘GOLD STANDARD’ FOR ≥CIN 2 1. Q 6-month follow-up of women with colposcopic diagnosis of ≤CIN 1 Not a good plan as many women are lost to follow-up Pretorius RG et al.Am J Obstet Gynecol 2006;195(5):1260-5 2. Performing LEEP or cone on a young woman with CIN 2 to avoid missing CIN 3 Many women with CIN 2 will resolve their infections without treatment, so if you knew the diagnosis was CIN 2, you might follow them. ACOG Committee Opinion #330 Obstet Gynecol 2006;107:963-8

  9. POOR SCIENCTIFIC CONCLUSIONS FROM USING A COLPOSCOPIC DIRECTED BIOPSY ‘GOLD STANDARD’ FOR ≥CIN 2 1. CIN is more frequent on the anterior lip of the cervix. Though colposcopically detected lesions are more common on the anterior lip, CIN (and microinvasive squamous cervical cancer) are radially distributed on the cervix. Pretorius RG et al. J Lower Genital Tract Disease 2006;10:45-50 2. The sensitivity of acetic acid aided visual inspection (VIA) for ≥CIN2 is about 65%. VIA and colposcopy are correlated (ie. they detect and miss many of the same lesions). When colposcopy is the ‘gold-standard’ in VIA screening studies, the sensitivity of VIA for ≥CIN 2 (and ≥CIN 3) is inflated. The actual sensitivity of VIA for ≥CIN 2 is closer to 45%. Pretorius RG et al. Int J Cancer 2007;121(10):2218-24

  10. METHOD OF DIAGNOSING WOMEN WITH CIN 2 OR WORSE (SPOCCS II) Colpo biopsy 208/364 (57.1%) Colpo biopsy + 2 o’clock 256/364 (70.3%) Colpo biopsy + 2, 4 o’clock 297/364 (81.6%) Colpo biopsy + 2, 4, 8 o’clock 329/364 (90.4%) Colpo biopsy + 2, 4, 8, 10 o’clock 344/364 (94.5%) Colpo biopsy + 2, 4, 8, 10 + ECC 364/364 (100%) 57.1% vs. 70.3% vs. 81.6% vs. 90.9% vs. 94.5% vs. 100%, Chi-Square = 326, df=5, p<.001

  11. SENSITIVITY OF COLPOSCOPY FOR CIN 2 OR WORSE AND RATE OF CIN 2 OR WORSE

  12. THIS PRESENTATION CAN BE DOWNLOADED FROM THE PREVENTIVE ONCOLOGY INTERNATIONAL (POI) WEBSITE www.poiinc.org

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