Agreement between colposcopic impression and histological diagnosis among human papillomavirus type 16‐positive women: a clinical trial using dynamic spectral imaging colposcopy

Abstract

Please cite this paper as: Zaal A, Louwers J, Berkhof J, Kocken M, ter Harmsel W, Graziosi G, Spruijt J, Balas C, Papagiannakis E, Snijders P, Meijer C, van Kemenade F, Verheijen R. Agreement between colposcopic impression and histological diagnosis among human papillomavirus type 16‐positive women: a clinical trial using dynamic spectral imaging colposcopy. BJOG 2012;119:537–544. 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. Design Prospective, comparative, multicentre clinical trial. Setting Three colposcopy clinics in the Netherlands. Population 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. Main outcome measures 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.