| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
ORIGINAL RESEARCH |
From the 1Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland; 2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; 3University of Washington School of Public Health and Community Medicine, Department of Epidemiology, Seattle, Washington; 4Department of Pathology, University of Washington, Seattle, Washington; 5Public Health - Seattle/King County, Washington; and 6Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland.
OBJECTIVE: To examine the influence that type of medical training and number of biopsies have on sensitivity of colposcopically guided biopsies.
METHODS: Among 408 women with an adequate enrollment colposcopy and a diagnosis of cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN 3+) over 2 years in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions (ASCUS-LSIL) Triage Study, we evaluated factors influencing the sensitivity of the enrollment colposcopic procedure. We used contingency table analysis to examine confounding variables and 
2 tests to ascertain statistical significance.
RESULTS: Overall, 69.9% of women with a cumulative diagnosis of CIN 3+ had a "true-positive" enrollment colposcopically guided biopsy result of CIN 2 or worse (CIN 2+), the threshold that would trigger excisional therapy. The sensitivity of the procedure did not vary significantly by type of colposcopist. However, the sensitivity was significantly greater when the colposcopists took two or more biopsies instead of one (P<.01), a pattern observed across all types of colposcopists. Independent of the severity of the colposcopic impression, the frequency with which colposcopists took two or more biopsies instead of one varied (in descending order) from nurse practitioners to general gynecologists to gynecologic oncology fellows to gynecologic oncologists (P<.01).
CONCLUSION: Colposcopy with guided biopsy or biopsies detects approximately two thirds of CIN 3+. Although the sensitivity of the procedure does not differ significantly by type of medical training, it is greater when two or more biopsies are taken.
LEVEL OF EVIDENCE: II-2
This article has been cited by other articles:
|
|
 |
|
  J. Koshiol, L. Lindsay, J. M. Pimenta, C. Poole, D. Jenkins, and J. S. Smith Persistent Human Papillomavirus Infection and Cervical Neoplasia: A Systematic Review and Meta-Analysis Am. J. Epidemiol., July 15, 2008; 168(2): 123 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. E. Castle Invited Commentary: Is Monitoring of Human Papillomavirus Infection for Viral Persistence Ready for Use in Cervical Cancer Screening? Am. J. Epidemiol., July 15, 2008; 168(2): 138 - 144. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. T. Cox More Questions About the Accuracy of Colposcopy: What Does This Mean for Cervical Cancer Prevention? Obstet. Gynecol., June 1, 2008; 111(6): 1266 - 1267. [Full Text] [PDF]
|
|
|
|
 |
|
 A. K. Wong, R. C.-K. Chan, W. S. Nichols, and S. Bose Human Papillomavirus (HPV) in Atypical Squamous Cervical Cytology: the Invader HPV Test as a New Screening Assay J. Clin. Microbiol., March 1, 2008; 46(3): 869 - 875. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Jeronimo, L. S. Massad, P. E. Castle, S. Wacholder, M. Schiffman, and for the National Institutes of Health (NIH) Americ Interobserver Agreement in the Evaluation of Digitized Cervical Images Obstet. Gynecol., October 1, 2007; 110(4): 833 - 840. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. S. Massad More Is More: Improving the Sensitivity of Colposcopy Obstet. Gynecol., August 1, 2006; 108(2): 246 - 247. [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
