After colposcopy, most women are followed with Pap smears annually until the abnormal cells go away. If your biopsy results show high level abnormality, you may need a LEEP conization. Loop Electrocautery Excision Procedure LEEP is a 10 minute in-office procedure that helps to prevent cervical cancer by removing abnormal cells from the cervix.
If nothing is done for her, the patient will likely go on to have invasive cervical cancer. A LEEP can be performed to remove that area from the cervix and prevent those cells from becoming cancerous.
Clinicopathologic characteristics of patients among the 3 subgroups are presented in Supplementary Table 2. We also performed subgroup analyses according to patients' ages. Overall rates for under-, correctly-, and over-diagnosed cases were In the current study, we evaluated the diagnostic performance of CDB in this population by comparing CDB results directly with LEEP results, and observed discrepancies between these procedures.
In contrast to our study that was limited to cytologic HSILs, most studies included patients with various types on baseline Pap tests. Owing to the differences in study details, direct comparisons of the concordance rates among the studies might be difficult.
Moreover, we demonstrated a high CDB false negative rate Among false negative cases, Therefore, we emphasize the substantial risk of misdiagnosis of actual cancer and the risk of progression of cervical dysplasia when the LEEP was not performed or delayed based on favorable CDB results in women with cytologic HSILs.
While some researchers pointed out an inherent inaccuracy of CDB as the main cause of the discrepancy, others have also investigated the factors that might affect agreement between CDB and excisional biopsy results. Using the database of the Gardasil clinical trials, Stoler et al. An Italian retrospective study reported that patients' age and invisibility of the squamocolumnar junction were associated with CDB under-diagnoses [ 19 ].
A recent Korean retrospective study suggested that baseline Pap test results and the number of vaginal deliveries as additional factors affecting the diagnostic discrepancies between the CDB and LEEP [ 15 ].
However, in this study, neither patients' age nor the presence of high-risk HPV was different between under-diagnosed cases and the other cases.
The main reason for such an inconsistency might be that we chose only women with cytologic HSILs as the study population, unlike the former 3 studies which did not restrict the baseline Pap results. Among the patients who underwent HPV testing, Although the study population in the study by Stuebs et al. Rather, we agree with the importance and value of colposcopy for the evaluation of abnormal or inconclusive cervical cancer screening tests [ 8 ].
We believe that there were 2 possible factors that might affect the diagnostic inaccuracy of CDB in this study: first, a proficiency issue among physicians performing CDB might exist. Some studies also reported the tendency of junior colposcopists to overestimate rather than underestimate colposcopic findings [ 21 ].
However, this study was retrospective, and we were unable to perform quality assessments of the CDB procedures. The accuracy of CDB might be improved or optimized by implementation of well-designed training and quality assurance programs for colposcopy practice [ 21 , 22 ].
Secondly, pathologic examination-related issues should be considered for CDB. Currently, additional biomarkers, such as cytokeratin 7 and topoisomerase IIa, have been proposed with promising results [ 26 , 27 , 28 ]. Therefore, a combined approach using these biomarkers is expected to increase the diagnostic accuracy of CDB.
The current study has several limitations. First, although we identified consecutive patients with clearly defined eligibility criteria, inevitable issues might arise in retrospective studies such as selection bias.
Secondly, as a single-institution study, sample size might be insufficient to determine the diagnostic performance of CDB with high accuracy. Lastly, we did not evaluate other risk factors for cervical dysplasia and cervical cancer, such as parity, smoking, socioeconomic status, and use of oral contraceptives. Despite this study's limitations, our results, using clearly defined methods, provide additional scientific evidence for the diagnostic inaccuracy of CDB, especially for those with cytologic HSILs.
Further prospective studies are warranted. Conflict of Interest: No potential conflict of interest relevant to this article was reported. Clinicopathologic characteristics of under-diagnosed and correctly or over-diagnosed patients.
National Center for Biotechnology Information , U. Journal List J Gynecol Oncol v. J Gynecol Oncol. Published online Aug Find articles by Se Ik Kim. Find articles by Se Jeong Kim. Find articles by Dong Hoon Suh. Find articles by Kidong Kim. Find articles by Jae Hong No. Find articles by Yong Beom Kim.
Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to Jae Hong No. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Supplementary Table 1 Clinicopathologic characteristics of under-diagnosed and correctly or over-diagnosed patients.
Supplementary Table 2 Clinicopathologic characteristics of patients among the 3 subgroups. Abstract Objective To investigate pathologic discrepancies between colposcopy-directed biopsy CDB of the cervix and loop electrosurgical excision procedure LEEP in women with cytologic high-grade squamous intraepithelial lesions HSILs.
Results Among the study population, Data collection At our institution, the standard practice for the management of women with abnormal Pap test results is in line with the current clinical guidelines of the ASCCP [ 7 ]. Statistical analysis Descriptive statistics were used to describe clinicopathologic characteristics of the study population. Patients' characteristics The selection of the study population is depicted in Fig. Open in a separate window. The generator transmits an electrical current that quickly cuts away the affected area of the cervical tissue in the immediate area of the loop wire.
This causes the abnormal cells to rapidly heat and burst, and separates the tissue as the loop wire moves through the cervix. This technique allows your physician to send the excised tissue to the pathologist for further evaluation. This insures that the abnormal area was completely removed, as well as allowing for a more accurate assessment of the abnormal cervical cells.
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