Diagnostic accuracy of colposcopically directed biopsy and loop electrosurgical excision procedure for cervical lesions

摘要

Objective: The aim of this study is to evaluate the diagnostic accuracy of colposcopically directed biopsy (CDB) and loop electrosurgical excision procedure (LEEP) for cervical lesions and assess their ability to detect glandular involvement. Methods: This retrospective study reviewed 4689 cervical lesions that were tested by CDB and LEEP at a tertiary hospital. The sensitivity, specificity, and predictive value of CDB and LEEP and the ratio of glandular involvement detected by these two methods were analyzed. Results: CDB and LEEP had sensitivities of 95.4% and 80.0%, respectively, for diagnosing high-grade intraepithelial or more severe lesions (HSIL+) (P = 0.000) and 31.8% and 87.9%, respectively, for diagnosing adenocarcinoma in situ or more severe lesions (AIS+) (P = 0.001). CDB and LEEP had sensitivities of 18.1% and 90.2%, respectively, for diagnosing invasive squamous cell carcinoma (P = 0.000) and 5.9% and 98.0%, respectively, for diagnosing invasive adenocarcinoma (P = 0.000). The negative predictive values of CDB and LEEP for diagnosing HSIL+ were 88.6% and 64.4%, respectively (P = 0.000). The ratios of glandular involvement were 0.2% (CDB) and 2.4% (LEEP) in low-grade intraepithelial lesions (LSILs) and 8.9% (CDB) and 59.0% (LEEP) (P = 0.000) in HSIL+. Conclusions: LEEP is superior to CDB for diagnosing AIS and detecting early invasive cancer. It should be offered as an additional investigation to all patients with AIS, HSIL, or LSIL with glandular involvement on CDB.