Agreement between colposcopic impression and histological diagnosis among human papillomavirus type 16-positive women: A clinical trial using dynamic spectral imaging colposcopy

Objective To investigate the agreement between conventional colposcopic impression, dynamic spectral imaging (DSI) colposcopy and histology, for human papillomavirus type 16-positive (HPV16 +) and non-16 high-risk (hr) HPV + women. Design Prospective, comparative, multicentre clinical trial. Setting Three colposcopy clinics in the Netherlands. Population Women (n = 177) aged 18 years or over with an intact cervix, referred for colposcopy. Methods The colposcopist graded the lesion by using the DSI colposcope as a regular video colposcope. Subsequently the DSI impression was displayed and biopsies were taken from all abnormal areas as well as from a random (normal) site. A cervical smear was taken for HPV typing. Main outcome measures Histologically confirmed high-grade cervical intraepithelial neoplasia or cancer (CIN2 +), positive for HPV16 or for any other hrHPV type. Results The DSI colposcope identified more CIN2 + cervical lesions among HPV16 + women than in non-16 hrHPV + women (P = 0.032 regardless of final histology and P = 0.009 among women with CIN2 +). Consequently, the sensitivity of the DSI colposcope for detecting CIN2 + lesions was higher in HPV16 + women than in non-16 hrHPV + women (97% versus 74%, P = 0.009). No such differences were seen for the colposcopist impression. In addition, mainly smaller cervical lesions are missed by the colposcopist. Conclusions The sensitivity of DSI colposcopy for CIN2 + is higher in HPV16 + than in non-16 hrHPV + women. Furthermore, regardless of HPV16 status, the sensitivity of DSI for CIN2 + is higher than that of the colposcopist, probably because colposcopists tend to miss smaller cervical lesions.

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