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Validation of the indication for colposcopy proposed by the 2019 ASCCP risk-based management consensus guidelines: A
Ting Gui1, Zhiyan Chen1, Fei Chen1
1Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetrics & Gynecologic Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Objective:
To validate the colposcopy indication proposed by the 2019 ASCCP Risk-Based Management Consensus Guidelines for abnormal cervical cancer screening tests (the 2019 ASCCP guidelines).
Methods:
Clinical data of 1404 patients who underwent colposcopy in single center in China were reviewed. Based on history and current cervical screening (HPV & cytology), corresponding recommendations were given according to the 2019 ASCCP guidelines. The agreement and discrepancy of colposcopy indication were analyzed between the Chinese consensus and the 2019 ASCCP guidelines.
Results:
Colposcopy indication was matched in about 80% patients. The left 20% were recommended with follow-up by the 2019 ASCCP guidelines. The discrepancy mainly focused on patients having a current result of HPV-positive NILM without unknown history. The ratio of observed CIN3+ in our database over estimated CIN3+ by the 2019 ASCCP guidelines was 6.2 (31/5). The ratio was even higher in patients with HPV16/18-positive NILM (7, 28/4), compared with those with other types of high-risk HPV-positive NILM (3, 3/1). The 2019 ASCCP guidelines had a relatively high sensitivity (83.1%), a low specificity (21.5%), a low positive predictive value (14.1%) and a high negative predictive value (89.1%) for prediction of CIN 3+.
Conclusions:
We could try to apply the 2019 ASCCP guidelines in Chinese population. The classification of HR-HPV was strongly recommended during risk assessment. For patients with HPV16/18 infection, colposcopy should be recommended. Perspective multi-center randomized controlled trial with reliable follow-up should be performed in the future to confirm the feasibility.
