Association of Cervical Screening Results with Colposcopic Findings

Abstract

Objective: Cervical cancer is the fourth most common female cancer. In addition to early cancer diagnosis, the screening strategy of cervical cancer is based on early diagnosis of precancerous lesions [high-grade cervical lesions (HSIL)] to prevent cancer progression. The evaluation of clinical findings is very important for the monitoring and further modifications of the present cancer screening programs. This study aimed to review the relationship between the admission characteristics, human papilloma virus (HPV) types, Papanicolaou smear results and the colposcopic diagnoses of the patients who were referred for colposcopy.Method: The characteristics and colposcopic diagnoses of 420 patients who were referred to a University Hospital between the years of 2016 and 2018 upon the detection of high-risk-HPV DNA positivity were evaluated retrospectively. The clinical properties, colposcopic findings, and sociodemographic features of the patients with HSIL and cancer were obtained through the file records.Results: During the study period, 21 patients with carcinoma in situ and/or cancer and 131 patients with HSIL had been diagnosed. When the patients with HSIL were analyzed, it was found that 76.3% (n=100) of the patients had HPV type 16 and/or 18 positivity, and 23.7% (n=31) of the patients had other types of high risk HPV positivity. Besides, it was observed that smear results were negative in approximately half of the cases (n=57, 50.9%). When different triage options to detect HSIL and above lesions were compared between each other, the highest sensitivity value (92.11%) and the highest negative predictive value (84.21%) were obtained by the triage of the patients with HPV 16 and/or 18 positivity and/or ASC-US and above. It was also observed that cytology alone was the triage method with the lowest sensitivity (30.92%)Conclusion: The results of the present study were compatible with the data of the current national cervical cancer screening program. Referring patients with HPV 16/18 and/or abnormal cytology to detect HSIL is a highly sensitive triage method. However, it should be considered that, even in this triage method, approximately 8% of the cases can be missed.