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Diagnostic accuracy of colposcopy-directed biopsy compared with LEEP histology: A retrospective cohort study
Katharina Kowoll1, Jens Hachenberg1, Jan Lennart Stalp1
1Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany.
Background:
Colposcopy-directed biopsy is widely used in the diagnosis of cervical dysplasia, but its accuracy is variable. Reliable detection of clinically significant lesions (CIN2+) is essential for appropriate treatment. This study assessed its diagnostic performance using histology after LEEP as the reference standard and explored factors associated with discrepancies.
Methods:
423 procedures were analyzed. Histological findings from colposcopy-directed biopsy were compared with the histology of the subsequent LEEP specimen. Diagnostic performance for CIN2+ was evaluated using sensitivity, specificity, predictive values, and accuracy; agreement was assessed using weighted Cohen's kappa. Subgroup analyses considered transformation zone (TZ) type, age, and menopausal status. Multivariable logistic regression assessed predictors of histopathological underestimation.
Results:
Biopsy showed 97.0% sensitivity, 20.0% specificity, and 80.6% accuracy for CIN2+ detection. Exact histological agreement occured in 61.7% of procedures (κ = 0.31). Histopathological underestimation occurred in 12.3% and overestimation in 26.0%, indicating a tendency toward overestimation. Exact agreement decreased from 75.8% in TZ1 to 48.0% in TZ3 and from 65.2% in premenopausal to 48.4% in postmenopausal patients. Complete-case multivariable analysis included 227 procedures and 23 underestimation events. Compared with TZ1, TZ2 and TZ3 were independently associated with higher odds of underestimation other included covariates were not.
Conclusion:
Colposcopy-directed biopsy shows high sensitivity but limited specificity for CIN2+ detection, with notable diagnostic discrepancies. Histological concordance was lower in patients with TZ 3 and in postmenopausal women, while TZ was independently associated with underestimation. These findings highlight the importance of considering anatomical and patient-related factors when interpreting biopsy results and planning clinical management.