The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia

L. Stewart Massad, Jose Jeronimo, Hormuzd A. Katki, Mark Schiffman, Sameer Antani, Lori Boardman, Peter Cartwright, Philip E. Castle, Charles Dunton, Julia Gage, Richard Guido, Fernando Guijon, Thomas Herzog, Warner Huh, Abner Korn, Edward Kost, Ramey D. Littell, Rodney Long, Jorge Morales, Leif NeveDennis O'Connor, Janet S. Rader, George Sawaya, Mario Sideri, Karen Smith-McCune, Mark Spitzer, Alan Waxman, Claudia Werner

Research output: Contribution to journalArticle

93 Citations (Scopus)

Abstract

OBJECTIVE. To relate aspects of online colposcopic image assessment to the diagnosis of grades 2 and 3 cervical intraepithelial neoplasia (CIN 2+). METHODS. To simulate colposcopic assessment, we obtained digitized cervical images at enrollment after acetic acid application from 919 women referred for equivocal or minor cytologic abnormalities into the ASCUS-LSIL Triage Study. For each, 2 randomly assigned evaluators from a pool of 20 colposcopists assessed images using a standardized tool online. We calculated the accuracy of these assessments for predicting histologic CIN 2+ over the 2 years of study. For validation, a subset of online results was compared with same-day enrollment colposcopic assessments. RESULTS. Identifying any acetowhite lesion in images yielded high sensitivity: 93% of women with CIN 2+ had at least 1 acetowhite lesion. However, 74% of women without CIN 2+ also had acetowhitening, regardless of human papillomavirus status. The sensitivity for CIN 2+ of an online colpophotographic assessment of high-grade disease was 39%. The sensitivity for CIN 2+ of a high-grade diagnosis by Reid Index scoring was 30%, and individual Reid Index component scores had similar levels of sensitivity and specificity. The performance of online assessment was not meaningfully different from that of same-day enrollment colposcopy, suggesting that these approaches have similar utility. CONCLUSIONS. Finding acetowhite lesions identifies women with CIN 2+, but using subtler colposcopic characteristics to grade lesions is insensitive. All acetowhite lesions should be assessed with biopsy to maximize sensitivity of colposcopic diagnosis with good specificity.

Original languageEnglish (US)
Pages (from-to)137-144
Number of pages8
JournalJournal of Lower Genital Tract Disease
Volume13
Issue number3
DOIs
StatePublished - Jul 2009
Externally publishedYes

Fingerprint

Cervical Intraepithelial Neoplasia
Colposcopy
Triage
Acetic Acid
Biopsy
Sensitivity and Specificity

Keywords

  • Acetowhite lesion
  • Biopsy
  • Cervical intraepithelial neoplasia
  • Colposcopy
  • Pap test

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Massad, L. S., Jeronimo, J., Katki, H. A., Schiffman, M., Antani, S., Boardman, L., ... Werner, C. (2009). The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia. Journal of Lower Genital Tract Disease, 13(3), 137-144. https://doi.org/10.1097/LGT.0b013e31819308d4

The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia. / Massad, L. Stewart; Jeronimo, Jose; Katki, Hormuzd A.; Schiffman, Mark; Antani, Sameer; Boardman, Lori; Cartwright, Peter; Castle, Philip E.; Dunton, Charles; Gage, Julia; Guido, Richard; Guijon, Fernando; Herzog, Thomas; Huh, Warner; Korn, Abner; Kost, Edward; Littell, Ramey D.; Long, Rodney; Morales, Jorge; Neve, Leif; O'Connor, Dennis; Rader, Janet S.; Sawaya, George; Sideri, Mario; Smith-McCune, Karen; Spitzer, Mark; Waxman, Alan; Werner, Claudia.

In: Journal of Lower Genital Tract Disease, Vol. 13, No. 3, 07.2009, p. 137-144.

Research output: Contribution to journalArticle

Massad, LS, Jeronimo, J, Katki, HA, Schiffman, M, Antani, S, Boardman, L, Cartwright, P, Castle, PE, Dunton, C, Gage, J, Guido, R, Guijon, F, Herzog, T, Huh, W, Korn, A, Kost, E, Littell, RD, Long, R, Morales, J, Neve, L, O'Connor, D, Rader, JS, Sawaya, G, Sideri, M, Smith-McCune, K, Spitzer, M, Waxman, A & Werner, C 2009, 'The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia', Journal of Lower Genital Tract Disease, vol. 13, no. 3, pp. 137-144. https://doi.org/10.1097/LGT.0b013e31819308d4
Massad, L. Stewart ; Jeronimo, Jose ; Katki, Hormuzd A. ; Schiffman, Mark ; Antani, Sameer ; Boardman, Lori ; Cartwright, Peter ; Castle, Philip E. ; Dunton, Charles ; Gage, Julia ; Guido, Richard ; Guijon, Fernando ; Herzog, Thomas ; Huh, Warner ; Korn, Abner ; Kost, Edward ; Littell, Ramey D. ; Long, Rodney ; Morales, Jorge ; Neve, Leif ; O'Connor, Dennis ; Rader, Janet S. ; Sawaya, George ; Sideri, Mario ; Smith-McCune, Karen ; Spitzer, Mark ; Waxman, Alan ; Werner, Claudia. / The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia. In: Journal of Lower Genital Tract Disease. 2009 ; Vol. 13, No. 3. pp. 137-144.
@article{d658a32ec9344bf4982359b8a9f51ac3,
title = "The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia",
abstract = "OBJECTIVE. To relate aspects of online colposcopic image assessment to the diagnosis of grades 2 and 3 cervical intraepithelial neoplasia (CIN 2+). METHODS. To simulate colposcopic assessment, we obtained digitized cervical images at enrollment after acetic acid application from 919 women referred for equivocal or minor cytologic abnormalities into the ASCUS-LSIL Triage Study. For each, 2 randomly assigned evaluators from a pool of 20 colposcopists assessed images using a standardized tool online. We calculated the accuracy of these assessments for predicting histologic CIN 2+ over the 2 years of study. For validation, a subset of online results was compared with same-day enrollment colposcopic assessments. RESULTS. Identifying any acetowhite lesion in images yielded high sensitivity: 93{\%} of women with CIN 2+ had at least 1 acetowhite lesion. However, 74{\%} of women without CIN 2+ also had acetowhitening, regardless of human papillomavirus status. The sensitivity for CIN 2+ of an online colpophotographic assessment of high-grade disease was 39{\%}. The sensitivity for CIN 2+ of a high-grade diagnosis by Reid Index scoring was 30{\%}, and individual Reid Index component scores had similar levels of sensitivity and specificity. The performance of online assessment was not meaningfully different from that of same-day enrollment colposcopy, suggesting that these approaches have similar utility. CONCLUSIONS. Finding acetowhite lesions identifies women with CIN 2+, but using subtler colposcopic characteristics to grade lesions is insensitive. All acetowhite lesions should be assessed with biopsy to maximize sensitivity of colposcopic diagnosis with good specificity.",
keywords = "Acetowhite lesion, Biopsy, Cervical intraepithelial neoplasia, Colposcopy, Pap test",
author = "Massad, {L. Stewart} and Jose Jeronimo and Katki, {Hormuzd A.} and Mark Schiffman and Sameer Antani and Lori Boardman and Peter Cartwright and Castle, {Philip E.} and Charles Dunton and Julia Gage and Richard Guido and Fernando Guijon and Thomas Herzog and Warner Huh and Abner Korn and Edward Kost and Littell, {Ramey D.} and Rodney Long and Jorge Morales and Leif Neve and Dennis O'Connor and Rader, {Janet S.} and George Sawaya and Mario Sideri and Karen Smith-McCune and Mark Spitzer and Alan Waxman and Claudia Werner",
year = "2009",
month = "7",
doi = "10.1097/LGT.0b013e31819308d4",
language = "English (US)",
volume = "13",
pages = "137--144",
journal = "Journal of Lower Genital Tract Disease",
issn = "1089-2591",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia

AU - Massad, L. Stewart

AU - Jeronimo, Jose

AU - Katki, Hormuzd A.

AU - Schiffman, Mark

AU - Antani, Sameer

AU - Boardman, Lori

AU - Cartwright, Peter

AU - Castle, Philip E.

AU - Dunton, Charles

AU - Gage, Julia

AU - Guido, Richard

AU - Guijon, Fernando

AU - Herzog, Thomas

AU - Huh, Warner

AU - Korn, Abner

AU - Kost, Edward

AU - Littell, Ramey D.

AU - Long, Rodney

AU - Morales, Jorge

AU - Neve, Leif

AU - O'Connor, Dennis

AU - Rader, Janet S.

AU - Sawaya, George

AU - Sideri, Mario

AU - Smith-McCune, Karen

AU - Spitzer, Mark

AU - Waxman, Alan

AU - Werner, Claudia

PY - 2009/7

Y1 - 2009/7

N2 - OBJECTIVE. To relate aspects of online colposcopic image assessment to the diagnosis of grades 2 and 3 cervical intraepithelial neoplasia (CIN 2+). METHODS. To simulate colposcopic assessment, we obtained digitized cervical images at enrollment after acetic acid application from 919 women referred for equivocal or minor cytologic abnormalities into the ASCUS-LSIL Triage Study. For each, 2 randomly assigned evaluators from a pool of 20 colposcopists assessed images using a standardized tool online. We calculated the accuracy of these assessments for predicting histologic CIN 2+ over the 2 years of study. For validation, a subset of online results was compared with same-day enrollment colposcopic assessments. RESULTS. Identifying any acetowhite lesion in images yielded high sensitivity: 93% of women with CIN 2+ had at least 1 acetowhite lesion. However, 74% of women without CIN 2+ also had acetowhitening, regardless of human papillomavirus status. The sensitivity for CIN 2+ of an online colpophotographic assessment of high-grade disease was 39%. The sensitivity for CIN 2+ of a high-grade diagnosis by Reid Index scoring was 30%, and individual Reid Index component scores had similar levels of sensitivity and specificity. The performance of online assessment was not meaningfully different from that of same-day enrollment colposcopy, suggesting that these approaches have similar utility. CONCLUSIONS. Finding acetowhite lesions identifies women with CIN 2+, but using subtler colposcopic characteristics to grade lesions is insensitive. All acetowhite lesions should be assessed with biopsy to maximize sensitivity of colposcopic diagnosis with good specificity.

AB - OBJECTIVE. To relate aspects of online colposcopic image assessment to the diagnosis of grades 2 and 3 cervical intraepithelial neoplasia (CIN 2+). METHODS. To simulate colposcopic assessment, we obtained digitized cervical images at enrollment after acetic acid application from 919 women referred for equivocal or minor cytologic abnormalities into the ASCUS-LSIL Triage Study. For each, 2 randomly assigned evaluators from a pool of 20 colposcopists assessed images using a standardized tool online. We calculated the accuracy of these assessments for predicting histologic CIN 2+ over the 2 years of study. For validation, a subset of online results was compared with same-day enrollment colposcopic assessments. RESULTS. Identifying any acetowhite lesion in images yielded high sensitivity: 93% of women with CIN 2+ had at least 1 acetowhite lesion. However, 74% of women without CIN 2+ also had acetowhitening, regardless of human papillomavirus status. The sensitivity for CIN 2+ of an online colpophotographic assessment of high-grade disease was 39%. The sensitivity for CIN 2+ of a high-grade diagnosis by Reid Index scoring was 30%, and individual Reid Index component scores had similar levels of sensitivity and specificity. The performance of online assessment was not meaningfully different from that of same-day enrollment colposcopy, suggesting that these approaches have similar utility. CONCLUSIONS. Finding acetowhite lesions identifies women with CIN 2+, but using subtler colposcopic characteristics to grade lesions is insensitive. All acetowhite lesions should be assessed with biopsy to maximize sensitivity of colposcopic diagnosis with good specificity.

KW - Acetowhite lesion

KW - Biopsy

KW - Cervical intraepithelial neoplasia

KW - Colposcopy

KW - Pap test

UR - http://www.scopus.com/inward/record.url?scp=68649094459&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=68649094459&partnerID=8YFLogxK

U2 - 10.1097/LGT.0b013e31819308d4

DO - 10.1097/LGT.0b013e31819308d4

M3 - Article

C2 - 19550210

AN - SCOPUS:68649094459

VL - 13

SP - 137

EP - 144

JO - Journal of Lower Genital Tract Disease

JF - Journal of Lower Genital Tract Disease

SN - 1089-2591

IS - 3

ER -