New diagnostic criteria of colposcopy for uterine cervix neoplasia

• Published in: The journal of obstetrics and gynaecology research 2017-02, Vol.43 (2), p.339-344
• Main Authors: Kashimura, Masamichi, Matsuura, Yusuke, Kawagoe, Toshinori, Toki, Naoyuki, Hachisuga, Toru
• Format: Article
• Language: English
• Subjects: Adult; Benign; Cancer; Cervix; Colposcopy; Colposcopy - statistics & numerical data; Cytology; diagnostic criteria; Female; Humans; Hysterectomy; Invasiveness; Middle Aged; Practice Guidelines as Topic; Uterine Cervical Neoplasms - diagnosis; uterine cervix neoplasia; Uterus
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.13199

Aim The purpose of this study is to present alternative diagnostic criteria of colposcopy using new parameters. Methods Colposcopic photographs were reviewed in 1649 patients from the past 23 years, including 283 benign lesions, 327 low‐grade squamous intraepithelial lesions (LSIL; cervical intraepithelial neoplasia 1), 549 high‐grade squamous intraepithelial lesions (HSIL; cervical intraepithelial neoplasia 2/3), 78 microinvasive cancers, and 412 invasive cancers. Abnormal colposcopic findings were divided into: minor or major; single, or a combination of two or three findings; and under half or over half circumferential size. Histopathological backgrounds were investigated according to these new parameters of colposcopic findings. Results Minor abnormal colposcopic findings were observed in 21% of LSIL, and major abnormal findings were seen in 52% of LSIL, 86% of HSIL, and 86% of microinvasions. A single major abnormal finding was observed in 64% of the cases with LSIL, while two abnormal findings were observed in 43% of HSIL, and three abnormal findings were observed in 44% of microinvasions. In qualifying major abnormal colposcopic findings, under half size was detected in 91% of LSIL and 74% of HSIL, and over half size was observed in 58% of microinvasions. From these results, the following diagnostic criteria were instituted: (i) LSIL – single, minor or major findings and under half size; (ii) HSIL – two or three major findings and under half size; (iii) microinvasion – three major findings and over half size; and (iv) invasive cancer – irregular surface with atypical vessels. Conclusion Our new diagnostic criteria of colposcopy are fully acceptable, based on their similar level of accuracy to cytology.