Agreement on Lesion Presence and Location at Colposcopy.
Journal
Journal of lower genital tract disease
ISSN: 1526-0976
Titre abrégé: J Low Genit Tract Dis
Pays: United States
ID NLM: 9704963
Informations de publication
Date de publication:
13 Nov 2023
13 Nov 2023
Historique:
medline:
14
11
2023
pubmed:
14
11
2023
entrez:
14
11
2023
Statut:
aheadofprint
Résumé
The reproducibility and sensitivity of image-based colposcopy is low, but agreement on lesion presence and location remains to be explored. Here, we investigate the interobserver agreement on lesions on colposcopic images by evaluating and comparing marked lesions on digitized colposcopic images between colposcopists. Five colposcopists reviewed images from 268 colposcopic examinations. Cases were selected based on histologic diagnosis, i.e., normal/cervical intraepithelial neoplasia (CIN)1 (n = 50), CIN2 (n = 50), CIN3 (n = 100), adenocarcinoma in situ (n = 53), and cancer (n = 15). We obtained digitized time-series images every 7-10 seconds from before acetic acid application to 2 minutes after application. Colposcopists were instructed to digitally annotate all areas with acetowhitening or suspect of lesions. To estimate the agreement on lesion presence and location, we assessed the proportion of images with annotations and the proportion of images with overlapping annotated area by at least 4 (4+) colposcopists, respectively. We included images from 241 examinations (1 image from each) with adequate annotations. The proportion with a least 1 lesion annotated by 4+ colposcopists increased by severity of histologic diagnosis. Among the CIN3 cases, 84% had at least 1 lesion annotated by 4+ colposcopists, whereas 54% of normal/CIN1 cases had a lesion annotated. Notably, the proportion was 70% for adenocarcinoma in situ and 71% for cancer. Regarding lesion location, there was no linear association with severity of histologic diagnosis. Despite that 80% of the CIN2 and CIN3 cases were annotated by 4+ colposcopists, we did not find increasing agreement on lesion location with histology severity. This underlines the subjective nature of colposcopy.
Identifiants
pubmed: 37963327
doi: 10.1097/LGT.0000000000000786
pii: 00128360-990000000-00092
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023, ASCCP.
Déclaration de conflit d'intérêts
The authors have declared they have no conflicts of interest.
Références
Schiffman M, Castle PE, Jeronimo J, et al. Human papillomavirus and cervical cancer. Lancet 2007;370:890–907.
Wentzensen N, Massad LS, Mayeaux EJ, et al. Evidence-based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. J Low Genit Tract Dis 2017;21:216–22.
Jeronimo J, Schiffman M. Colposcopy at a crossroads. Am J Obstet Gynecol 2006;195:349–53.
Perkins R, Jeronimo J, Hammer A, et al. Comparison of accuracy and reproducibility of colposcopic impression based on a single image versus a two-minute time series of colposcopic images. Gynecol Oncol 2022;167:89–95.
Jeronimo J, Massad LS, Castle PE, et al. Interobserver agreement in the evaluation of digitized cervical images. Obstet Gynecol 2007;110:833–40.
Ferris DG, Litaker M; ALTS Group. Interobserver agreement for colposcopy quality control using digitized colposcopic images during the ALTS trial. J Low Genit Tract Dis 2005;9:29–35.
Massad LS, Jeronimo J, Katki HA, et al; National Institutes of Health/American Society for Colposcopy and Cervical Pathology Research Group. The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia. J Low Genit Tract Dis 2009;13:137–44.
ASCUS-LSIL Trige Study (ATLS) Group. Results of a randomized trial on the management of cytology interpretations of atypical squamous cells of undetermined significance. Am J Obstet Gynecol 2003;188:1383–92.
ASCUS-LSIL Traige Study (ATLS) Group. A randomized trial on the management of low-grade squamous intraepithelial lesion cytology interpretations. Am J Obstet Gynecol 2003;188:1393–400.
Perkins RB, Guido RS, Castle PE, et al. 2019 ASCCP Risk-Based Management Consensus Guidelines for Abnormal Cervical Cancer Screening Tests and Cancer Precursors. J Low Genit Tract Dis 2020;24:102–31.
Wentzensen N, Walker JL, Gold MA, et al. Multiple biopsies and detection of cervical cancer precursors at colposcopy. J Clin Oncol 2015;33:83–9.
Booth BB, Petersen LK, Blaakaer J, et al. Accuracy of colposcopy-directed biopsy vs dynamic spectral imaging directed biopsy in correctly identifying the grade of cervical dysplasia in women undergoing conization: a methodological study. Acta Obstet Gynecol Scand 2020;99:1064–70.
Sharp L, Cotton S, Cochran C, et alTOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) Group. After-effects reported by women following colposcopy, cervical biopsies and LLETZ: results from the TOMBOLA trial. BJOG 2009;116:1506–14.
Louwers J, Zaal A, Kocken M, et al. Dynamic spectral imaging colposcopy: higher sensitivity for detection of premalignant cervical lesions. BJOG 2011;118:309–18.
Cholkeri-Singh A, Lavin PT, Olson CG, et al. Digital colposcopy with dynamic spectral imaging for detection of cervical intraepithelial neoplasia 2+ in low-grade referrals: the IMPROVE-COLPO study. J Low Genit Tract Dis 2018;22:21–6.
DeNardis SA, Lavin PT, Livingston J, et al. Increased detection of precancerous cervical lesions with adjunctive dynamic spectral imaging. Int J Womens Health 2017;9:717–25.
Dice L. Measures of the amount of ecologic assocation between species. Ecology 1945;26:298–302.
Massad LS, Jeronimo J, Schiffman M; National Institutes of Health/American Society for Colposcopy and Cervical Pathology (NIH/ASCCP) Research Group. Interobserver agreement in the assessment of components of colposcopic grading. Obstet Gynecol 2008;111:1279–84.
Liu AH, Gold MA, Schiffman M, et al. Comparison of colposcopic impression based on live colposcopy and evaluation of static digital images. J Low Genit Tract Dis 2016;20:154–61.
Gage JC, Hanson VW, Abbey K, et al. Number of cervical biopsies and sensitivity of colposcopy. Obstet Gynecol 2006;108:264–72.
Booth BB, Petersen LK, Blaakaer J, et al. Dynamic spectral imaging colposcopy versus regular colposcopy in women referred with high-grade cytology: a nonrandomized prospective study. J Low Genit Tract Dis 2021;25:113–8.
O'Connor M, Gallagher P, Waller J, et al. Adverse psychological outcomes following colposcopy and related procedures: a systematic review. BJOG 2016;123:24–38.
Valls J, Baena A, Venegas G, et al. Performance of standardised colposcopy to detect cervical precancer and cancer for triage of women testing positive for human papillomavirus: results from the ESTAMPA multicentric screening study. Lancet Glob Health 2023;11:e350–60.
Lei J, Ploner A, Elfström KM, et al. HPV Vaccination and the risk of invasive cervical cancer. N Engl J Med 2020;383:1340–8.
Jeronimo J, Massad LS, Schiffman M; National Institutes of Health/American Society for Colposcopy and Cervical Pathology (NIH/ASCCP) Research Group. Visual appearance of the uterine cervix: correlation with human papillomavirus detection and type. Am J Obstet Gynecol 2007;197:47.e1–8.
Beecroft M, Gurumurthy M, Cruickshank ME. Clinical performance of primary HPV screening cut-off for colposcopy referrals in HPV-vaccinated cohort: observational study. BJOG 2023;130:210–3.
Alfonzo E, Holmberg E, Milsom I, et al. Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross-sectional study. BJOG 2022;129:1261–7.
Tidy JA, Brown BH, Healey TJ, et al. Accuracy of detection of high-grade cervical intraepithelial neoplasia using electrical impedance spectroscopy with colposcopy. BJOG 2013;120:400–10; discussion 410-1.
Wright VC. Colposcopy of adenocarcinoma in situ and adenocarcinoma of the uterine cervix: differentiation from other cervical lesions. J Low Genit Tract Dis 1999;3:83–97.
Castle PE, Rodríguez AC, Burk RD, et al. Neither one-time negative screening tests nor negative colposcopy provides absolute reassurance against cervical cancer. Int J Cancer 2009;125:1649–56.