The Values of Colposcopy in Patients with the Diagnosis of the High-Grade Squamous Intraepithelial Lesion in Routine Papanicolaou Test

Cervical cancer is one of the most preventable malignancies that can also be diagnosed in the early stages through screening tests. The Papanicolaou test (Pap smear) is the most conventional means for screening, while studies represent acceptable and more accurate outcomes of colposcopy in contrast to Pap smear. The current study aims to assess the values of colposcopy for cervical cancer diagnosis.

This is a cross-sectional study conducted on 94 patients diagnosed with high-grade squamous intraepithelial lesion (HSIL). After that, colposcopy was performed for all patients, and findings were presented as normal, chronic cervicitis, the thin acetowhite lesion (AWL), dense/thick AWL, AVP, pilling, and cauliflower-like mass. The biopsies were taken and pathological studies, as the gold standard was interpreted as normal, cervicitis, atypical squamous cells of undetermined significance (ASCUS), cervical intraepithelial neoplasia-1, -2 or -3 (CIN-1, -2 or -3), carcinoma-in-situ (CIS), adenocarcinoma and invasive squamous cell carcinoma (SCC).

The pap-smear results were significantly associated with the biopsy reports (P<0.001; kappa=0.225). Besides, significant concordance was found between colposcopy and biopsy (P<0.001; kappa=0.247). The total sensitivity and specificity of colposcopy were based on the biopsy findings as the gold standard was 97% and 41%, respectively (P<0.001).

Colposcopy was significantly sensitive and specific for diagnosing both non-malignant CIN-1 and malignant cervical lesions, but not for CIN-2, -3, and CIS lesions. Further evaluations are strongly recommended.