Background:
Aim:
To evaluate the test characteristics of colposcopy performed on women with positive visual inspection with acetic acid (VIA) and/or human papillomavirus (HPV) tests using histology as gold standard.
Methods:
A total of 30,773 women were screened by VIA and high-risk HPV test. Hybrid Capture 2 (HC2) technique was used for HPV detection. All women positive on VIA had colposcopy immediately and the HC2 positive women were recalled later for colposcopy. Among the test negative women 8.7% had colposcopy. The International Federation of Cervical Pathology & Colposcopy (IFCPC) 2011 nomenclature was used for classification of abnormalities. All women with Grade-1 or worse lesions had biopsies. Biopsies were also obtained from HC2 positive women with normal colposcopy.
Results:
Colposcopy and satisfactory biopsy reports were available from 2466 women. Overall strength of agreement between colposcopy and histologic classification of cervical neoplasias was poor (kappa=0.17). Previous studies evaluating colposcopy in cytology-based programs also observed such poor agreement. Agreement was better when colposcopy was done in HC2-positive than in VIA-positive women. Sensitivity of colposcopy to detect high-grade squamous intraepithelial lesions (HSIL) was 84.8% after correction of verification bias, again comparable to sensitivities of colposcopy on cytology-positive women. Positive predictive value of colposcopy was significantly higher in VIA-positive than in HC2-positive women. Random punch biopsies detected 13.6% of the HSILs in absence of colposcopic abnormalities and all of them were HC2 positive.
Conclusions:
Sensitivity of colposcopy and agreement between colposcopic and histologic diagnosis are comparable between cytology based and non-cytology based cervical cancer screening programs.