Number of cervical biopsies and sensitivity of colposcopy

被引:267
作者
Gage, Julia C.
Hanson, Vivien W.
Abbey, Kim
Dippery, Susan
Gardner, Susi
Kubota, Janet
Schiffman, Mark
Solomon, Diane
Jeronimo, Jose
机构
[1] Univ Washington, Sch Publ Hlth & Community Med, Dept Epidemiol, Seattle, WA 98199 USA
[2] NCI, Div Canc Epidemiol & Genet, NIH, US Dept HHS, Bethesda, MD 20892 USA
[3] Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD USA
[4] Univ Washington, Dept Pathol, Seattle, WA 98199 USA
[5] Publ Hlth Seattle King Cty, Seattle, WA USA
[6] NCI, Div Canc Prevent, NIH, US Dept HHS, Bethesda, MD 20892 USA
关键词
D O I
10.1097/01.AOG.0000220505.18525.85
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
OBJECTIVE: To examine the influence that type of medical training and number of biopsies have on sensitivity of colposcopically guided biopsies. METHODS: Among 408 women with an adequate enrollment colposcopy and a diagnosis of cervical intraepithelial neoplasia (CIN) 3 or cancer (CIN 3+) over 2 years in the Atypical Squamous Cells of Undetermined Significance/Low-Grade Squamous Intraepithelial Lesions (ASCUS-LSIL) Triage Study, we evaluated factors influencing the sensitivity of the enrollment colposcopic procedure. We used contingency table analysis to examine confounding variables and chi(2) tests to ascertain statistical significance. RESULTS: Overall, 69.9% of women with a cumulative diagnosis of CIN 3+ had a "true-positive" enrollment colposcopically guided biopsy result of CIN 2 or worse (CIN 2+), the threshold that would trigger excisional therapy. The sensitivity of the procedure did not vary significantly by type of colposcopist. However, the sensitivity was significantly greater when the colposcopists took two or more biopsies instead of one (P <.01), a pattern observed across all types of colposcopists. Independent of the severity of the colposcopic impression, the frequency with which colposcopists took two or more biopsies instead of one varied (in descending order) from nurse practitioners to general gynecologists to gynecologic oncology fellows to gynecologic oncologists (P <.01). CONCLUSION: Colposcopy with guided biopsy or biopsies detects approximately two thirds of CIN 3+. Although the sensitivity of the procedure does not differ significantly by type of medical training, it is greater when two or more biopsies are taken.
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页码:264 / 272
页数:9
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