Colposcopic findings discussed at the MDT meeting

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In a meta-analysis (Mitchell et al. 1998), colposcopy was highly sensitive (96% weighted average) in the diagnosis of a normal versus abnormal cervix and 85% for normal/LSIL versus high-grade CIN. Specificity was lower (48% and 69% respectively).

Through its high sensitivity, colposcopy effectively provides a method of increasing the specificity of HPV+ or ASC-US+ results.

Colposcopy is less sensitive in the detection of AIS/CGIN and occult adenocarcinoma (Jordan et al. 2008; Talaat et al. 2012)..

Lesions high in the canal, especially in older women, may be difficult to detect because the squamocolumnar junction recedes into the canal.

The low PPV (but high sensitivity) of HPV testing for test of cure after treatment of high-grade CIN is a challenge to colposcopy in women at relatively high risk of cancer when small areas of persistent CIN may not be visible on the surface of the cervix.

Practical implications of colposcopy findings at MDT meeting

Negative colposcopy in the presence of HSIL or AIS may lead to treatment after review and confirmation of the cytological findings
Thresholds for treatment (CIN1 and CIN2) should take account of persistence, HPV type and histology review
Accuracy of colposcopic assessment of HSIL should be taken in the context of the representativeness and interpretation of punch biopsies and LLETZ