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Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesions
O Kierkegaard1, C Byrjalsen, K H Frandsen
1Department of Obstetrics and Gynecology, Herning Hospital, Denmark.
Objective:
To evaluate the diagnostic accuracy of cytology and colposcopy in women with an abnormal cervical smear using histology as the 'gold standard'.
Design:
Survey of consecutively referred women with abnormal smear.
Setting:
The out-patient colposcopical clinic of Herning Hospital, Denmark.
Patients:
813 women with a median age of 29.0 years (range 15-71 years) with their first abnormal smear.
Results:
For detecting cervical high-grade lesions (HGL) the sensitivity of cytology was 41% (36-47%), of colposcopy 67% (62-72%) and in combination 75% (70-80%), so at least 25% of HGL were underestimated. Colposcopy underestimated more CIN-2 than CIN-3 lesions and more small lesions and lesions in smaller transformation zones. Cytology underestimated more CIN-2 lesions but equal numbers of small and large lesions and transformation zones.
Conclusions:
Colposcopy was a better tool for diagnosing HGL than cytology, but even in combination too many HGL were missed. All women with abnormal cytology should therefore have colposcopical and histological investigation and prospective studies of the natural history of cervical squamous lesions should include histological evidence.