Prediction of cervical epithelial lesions level in patients with positive cytologic findings using colposcopic classification Rio De Janeiro 2011

Purpose of Investigation: Standard procedure for diagnosis of premalignant cervical changes includes cytological, colposcopic, and histopathological examination. Comparison of the results depends on classifications differences that may influence diagnosis. The aim of this study was to determine efficacy and accuracy of Rio de Janeiro classification in colposcopic prediction of cervical intraepithelial neoplasia (CIN) degree. Materials and Methods: The authors conducted a prospective study over a one-year period. Colposcopic findings were compared with histopathological results. Tumors were classified according to the WHO 2014 criteria. Results: The accuracy of colposcopy is higher for high-grade squamous intraepithelial lesion (HSIL). For major changes and height grade CIN 76% compatibility was found, but in patients without intraepithelial lesion, the compatibility was only 14%. Squamous cell cervical cancer was recognized in 67% of patients and in 33% of patients with cervical planocellular cancer was classified as colposcopic G2 change, which in terms of clinical use can be a satisfactory result. Conclusion: Combination of cytology screening and colposcopy is a go method in the detection of epithelial premalignant and early stages of malignant changes of the cervix.

Cervical intraepithelial neoplasia; Colposcopy; Papanicolaou smear; Cervical cancer screening; Sensitivity; Specificity.

[1] Bornstein J., Bentley J., Bösze P., Girardi F., Haefner H., Menton M., et al.: “2011 Colposcopic Terminology of the International Federation for Cervical Pathology and Colposcopy”. Obstet Gynecol., 2012, 120, 166.

[2] Kurman, R.J., Carcangiu, M.L., Herrington, C.S., Young, R.H. “WHO Classification of Tumours of Female Reproductive Organs”. Fourth Edition. Lyon: International Agency for Research on Cancer. 2014, 172.

[3] Ovanin-Rakić A., Pajtler M., Stanković T., Audy-Jurković S., Ljubojević N.: “The Classification of Cytologic Findings of Cervix Uteri »Zagreb 2002« The Modification of the »Zagreb 1990« and »NCI Bethesda System 2001« Classifications”. Gynaecol Perinatol., 2003, 12, 148.

[4] Kolposkopski obrazac “Rio de Janeiro/Zagreb 2011”. Available at: http://www.hdgo.hr/Default.aspx?sifraStranica=523

[5] Croatian National Cancer Registry: “Cancer Incidence in Croatia 2011, Bulletin No. 36”. Zagreb: Croatian National Institute of Public Health, 2011.

[6] Hinselmann H.: “Verbesserung der Inspektionsmöglichkeit von Vulva, Vagina und Portio”. Münchner Medizinische Wochenschrift., 1925, 77, 1733.

[7] Wespi H.: Early carcinoma of the uterine cervix: pathogenesis and detection. New York: Grune and Stratton, 1949.

[8] Hinselmann H.: “Die Essigsäureprobe als Bestandteil der erweiterten Kolposkopie.” Deutsche Medizinische Wochenschrift. 1938, 2, 40.

[9] Papanicolaou G.N., Traut H.F. “The diagnostic value of vaginal smears in carcinoma of the uterus”. Am J Gynecol Obset., 941, 42, 193.

[10] Olaniyan O.B.: “Validity of colposcopy in the diagnosis of early cervical neoplasia – A review”. Afr. J. Reprod. Health, 2002, 6, 59

[11] Grubisić G., Klarić P., Jokanović L., Soljacić Vranes H., Grbavac I., Bolanca I.: “Diagnostic approach for precancerous and early invasive cancerous lesions of the uterine cervix”. Coll. Antropol., 2009, 33, 1431.

[12] Grubisic G.: “Limitations of colposcopy in early invasive cervical cancer Detection”. Coll. Antropol., 2007, 31, 135.

[13] Redman C., Jordan J.: “How can the European Federation for Colposcopy promote high quality colposcopy throughout Europe?” Coll. Antropol., 2007, 31, 131.

[14] Boscha M.C., Rietweld-Scheffers P.E.M., Boon M.E.: “Characteristics of false-negative smears in the normal screening population”. Acta Cytol., 1992, 36, 711.

[15] Sherman M.E., Kelly D.: “High-grade squamous intraepithelial lesionsand invasive cancer following the report of three negativePapanicolaou smears: screening failure or rapid progression”. Mod. Pathol., 1992, 5, 327.

[16] Pajtler M., Audy-Jurković S., Kardum-Skelin I., Mahovlić V., Mozetic-Vrdoljak D., Ovanin-Rakić A.: “Organisation of Cervical Cytology Screening in Croatia: Past, Present and Future”. Coll. Antropol., 2007, 31, 47

[17] Castle P.E., Stoler M.H., Wright T.C. Jr, Sharma A., Wright T.L., Behrens C.M.: “Performance of carcinogenic human papillomavirus (HPV) testing and HPV16 or HPV 18 genotyping for cervical cancer screening of women aged 25 years and older: a subanalysis of the Athena”. Lancet Oncol., 2011, 12, 880.

[18] Leyden W.A., Manos M.M., Geiger A.M., Weinmann S., Mouchawar J., Bischoff K. et al.: “Cervical cancer in women with comprehensive health care access: attributable factors in the screening process”. J. Natl. Cancer Inst., 2005, 97, 675.

[19] Andrae B., Kemetli L., Sparén P., Silfverdal L., Strander B., Ryd W., et al.: “Screening-preventable cervical cancer risks: evidence from a nationwide audit in Sweden”. J. Natl. Cancer Inst., 2008, 100, 622.

[20] Agency for Healthcare Research and Policy: “Evaluation of Cervical Cytology. Summary, Evidence Report/Technology Assessment: Number 5” January 1999. Rockville, MD: AHCPR. Available at: http://www.ahcpr.gov/clinic/epcsums/cervsumm.htm

[21] Stafl A., Mattingly R.F.: “Colposcopic diagnosis of cervical neopla-sia”. Obstet. Gynecol., 1973, 41, 168.

[22] Ronk D.A., Jimerson G.K., Merrill J.A.: “Evaluation of abnormal cervical cytology”. Obstet. Gynecol. 1977, 49, 581.

[23] Stafl A.: “New nomenclature for colposcopy. Report of the committee on terminology”. Obstet. Gynecol., 1976, 48, 123.

[24] Stafl A., Wilbanks G.D.: “An International Terminology of Colposcopy: Report on The Nomenclature Committee of The International Federation of Cervical Pathology And Colposcopy”. Obstet. Gynecol. 1991, 77, 13.

[25] Walker P., Dexeus S., De Palo G., Barrasso R., Campion M., Girardi F. et al.: “International terminology of colposcopy: an updated report from the International Federation for Cervical Pathology and Colposcopy”. Obstet. Gynecol., 2003, 101, 175.

[26] Coppleson M.: “Colposcopic features of papillomaviral infection andpremalignancy on the lower genital tract”. Obstet. Gynecol. Clin. North Am., 1987, 14, 471.

[27] Reid R., Herschman B.R., Crum C.P., Fu Y.S., Braun L., Shah K.V., et al.: “Genital warts and cervical cancer: V. The tissue basis of colpo-scopic change”. Am. J. Obstet. Gynecol., 1984, 149, 293.

[28] Reid R., Herschman B.R., Crum C.P., Fu Y.S., Braun L, Shah K.V. et al.: ”Genital warts and cervical cancer: IV. Acolposcopic index for differ-entiating subclinical papillomaviral infection from cervical intraep-ithelial neoplasia”. Am. J. Obstet. Gynecol., 1984, 149, 815.

[29] Reid R., Scalzi P.: “Genital warts and cervical cancer. VII. Animproved colposcopic index for differentiating benign papillomavi-ral infections from high-grade cervical intraepithelial neoplasia”. Am. J. Obstet. Gynecol., 1985, 153, 611.

[30] Massad L.S., Collins Y.C.: “Strength of correlations between colposcopic impression and biopsy histology”. Gynecol. Oncol., 2003, 89, 424.

[31] Solomon D., Davey D., Kurman R., Moriarty A., O’Connor D., Prey M., et al.: “The 2001 Bethesda System: Terminology for Reporting Results of Cervical Cytology”. JAMA, 2002, 287, 2114.

[32] National Cancer Institute Workshop.: “The 1988 Bethesda System for reporting cervical/vaginal cytologic diagnoses. Developed and approved at the National Cancer Institute Workshop. Bethesda, Maryland, USA, December 12-13, 1988”. Acta Cytol., 1989, 33, 567.

[33] “The revised Bethesda System for reporting cervical/vaginal cytologic diagnoses. Report of the 1991 Bethesda workshop”. Acta Cytol., 1992, 36, 173.

[34] Bethesda 2001: “2001 terminology and recommendations”. Available at: http:Archive.is/bethesda2001.cancer.gov

[35] Okagaki T., Fujimura M., Zelterman D.: “Information, discrimination and divergence in cytology. III. Optimization of classification of Papanicolaou smears”. Acta Cytol., 1991, 35, 30.

[36] Minorchio E., Bianco V., Corso F.: “Advantages of topical therapy with polydeoxyribonucleotide in reparative processes after cauterization: experience at a center for early diagnosis of genital neoplasms”. Ann. Obstet. Gynecol. Med. Perinat., 1990, 111, 388.

[37] El-Shalakany A.H., Saeed M.M., Abdel-Aal M.R., El-Nakeeb A.H., Noseirat N., Ayyad S.B., El Din Z.S.: “Direct visual inspection of the cervix with Lugol’s iodine for the detection of premalignant lesions”. J. Low. Genit. Tract Dis., 2008, 12, 193.

[38] Ferris D.G., Litaker M.S.; ALTS Group.: “Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS”. Am. J. Obstet. Gynecol., 2006, 194, 704.

[39] HDGO POSTUPNIK: “Cervikalne Intraepitelne Lezije”. Available at: www.hdgo.hr/Default.aspx?sifraStranica=642

[40] Nessa A., Wistrand C., Begum S.A., Thuresson M., Shemer I., Thorsell M., Shemer E.A.: “Evaluation of Stationary Colposcope and the Gynocular, by the Swede Score Systematic Colposcopic System in VIA Positive Women: A Crossover Randomized Trial”. Int. J. Gynecol. Cancer, 2014, 24, 339.

[41] Tapisiz O.L., Ertan K., Tyner J., Borahay M., Freeman D.H., Kilic G.S.: “Cytology at the time of cervical colposcopy”. Eur. J. Gynaecol. Oncol., 2013, 34, 36.

[42] Adamopoulou M., Kalkani E., Charvalos E., Avgoustidis D., Haidopoulos D., Yapijakis C.: “Comparison of cytology, colposcopy, HPV typing and biomarker analysis in cervical neoplasia”. Anticancer Res., 2009, 29, 3401

[43] Kliemann L.M., Silva M., Reinheimer M., Rivoire W.A., Capp E., Dos Reis R.: “Minimal cold knife conization height for high-grade cervical squamous intraepithelial lesion treatment”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2012, 165, 342.