Comparative analysis of cytological and histological examination in abnormal colposcopic pictures: A literature review
DOI:
https://doi.org/10.37800/RM.4.2023.52-57Keywords:
colposcopy, cervical cancer (CC), histological studies, uterine pathology, human papillomavirus (HPV)Abstract
Relevance: Colposcopy, currently included in the WHO recommendations as a triage method for women infected with human papillomavirus (HPV), remains the reference standard for biopsies to confirm precancer and cervical cancer and deciding on treatment approaches. Every year, more than 600,000 new cases of cervical cancer are registered worldwide, leading to almost 350,000 deaths. More than 90% of deaths occur in low- and middle-income countries where screening efforts have been suboptimal.
The traditional screening approach based on cytology, colposcopy, histological confirmation, and treatment of cervical diseases has been successful in reducing the incidence of cervical cancer when applied systematically and widely. However, this approach has rarely been effective in low- and middle-income countries.
The study aimed to determine the diagnostic value of cytological and histological examination and colposcopy in identifying precancerous and malignant lesions of the cervix and to search for the reasons for the discrepancy in research results.
Materials and Methods: We conducted a literature review on cytological and histological studies in women with an abnormal colposcopic picture. Search keywords for the PubMed database included colposcopy, cervical cancer, histological studies, uterus pathology, human papillomavirus. Inclusion criteria: full-text open-access articles; publications of level of evidence A, B: meta- analyses, systematic reviews, cohort and cross-sectional studies.
Results: Over the past decade, HPV testing has gradually replaced cytology in primary screening. High sensitivity of HPV testing comes at the expense of lower specificity; therefore, a second triage test is usually required to reduce referrals and overtreatment. Current WHO guidelines recommend the use of HPV testing for initial screening and suggest either treatment of all HPV-positive women or a screening, triage, and treatment approach using partial genotyping, colposcopy, acetic acid visual inspection, or cytology to triage women after a positive HPV test.
Conclusion: Thus, most problems associated with cervical cancer screening limitations were related to the cytology's inconsistent quality and low sensitivity.
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