Diagnostic Accuracy Rate of Tertiary Center Colposcopy Unit

Colposcopy plays a central role in the evaluation of cervical intraepithelial lesions; however, its diagnostic performance varies widely. While high sensitivity is desirable, low specificity may lead to unnecessary excisional procedures. This study aimed to evaluate the diagnostic performance of colposcopy and its potential contribution to overtreatment in a tertiary referral center.

This retrospective single-center study included 150 patients who underwent LEEP between April 2023 and September 2024. Colposcopic impressions were compared with LEEP histopathological outcomes. Sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios were calculated. A subgroup analysis was performed for HPV16-positive patients.

Colposcopy demonstrated high sensitivity (93.9%, 95% CI: 87.3-97.4) but low specificity (31.4%, 95% CI: 20.2-45.0), with an overall accuracy of 72.7% (95% CI: 65.0-79.2). The PPV and NPV were 72.6% (95% CI: 64.2-79.7) and 72.7% (95% CI: 51.9-86.9), respectively. The positive and negative likelihood ratios were 1.37 and 0.19. Notably, 35 patients (23.3%) were false positives. In HPV16-positive patients, sensitivity was 80.8% (95% CI: 71.7-87.5), specificity was 33.3% (95% CI: 21.9-47.1), and accuracy was 64.7% (95% CI: 56.7-72.0).

Although colposcopy is highly sensitive, its low specificity may result in substantial overtreatment, particularly in tertiary referral settings.