1. Colposcopy performance in the new primary HPV screening in Australia: How to determine colposcopy competency?
- Author
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Tan, Jeffrey H.J., Neesham, Deborah, Szabo, Rebecca A., Khomko, Natalia, Yap, Desiree, and Wrede, C. David H.
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PAPILLOMAVIRUS disease diagnosis , *CYTOLOGY , *BIOPSY , *CERVIX uteri diseases , *EARLY detection of cancer , *SCIENTIFIC observation , *RETROSPECTIVE studies , *DESCRIPTIVE statistics , *COLPOSCOPY , *DYSPLASIA , *MEDICAL records , *ACQUISITION of data , *CONFIDENCE intervals , *SENSITIVITY & specificity (Statistics) - Abstract
Aims: To assess colposcopic performance and determine indicators for competency within the new Australian primary human papillomavirus (HPV) cervical screening program. Materials and methods: A retrospective observational study of 4542 women seen at The Royal Women's Hospital Colposcopy Clinic in Melbourne, from 1 December 2017 to 31 July 2020 after a higher‐risk cervical screening test (CST) result. Results: Histological CIN2+ was detected in 25.1% up to two years from first colposcopy visit (FCV). The majority (86.7%) of CIN2+ was detected early within the first six months of presentation. Biopsy rate overall was 96.1% with abnormal colposcopic impression. Of four colposcopists with a lower biopsy rate, only one was able to achieve this early detection rate. Biopsy was also taken in over 30% of cases with negative reflex cytology and normal colposcopy, with CIN2+ detected in 5.0% among positive HPV16/18 and 3.8% with non‐16/18 HPV. Positive predictive value of high‐grade colposcopic impression at FCV averaged 66.4% (range: 54.9–81.6% among our colposcopists) and is poorly correlated with early detection rate of CIN2+. Overall accuracy of colposcopy is 84.5% (range: 78.7–90.3%), buoyed by high true negative colposcopic predictions secondary to high rates of negative reflex cytology referral with the new screening algorithm and is also unlikely to be a useful colposcopy indicator. Conclusions: Early detection rate of CIN2+ within the first six months of presentation is a useful measure of colposcopy competency and we would encourage our National Cancer Screening Register to explore this with the participating colposcopists. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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