Colposcopy failure in HPV screening

Thesis Colposcopy has been mainly used to detect cervical intraepithelial neoplasia (CIN 2 or CIN 3) among women with abnormal Pap smears. New screening concept based on HPV testing select patients with normal cytology for colposcopy because of HPV persistency.

We already showed a significantly increased risk of missing CIN3+ at first colposcopy in women with normal cytology but HPV persistence compared with abnormal cytology.

Methods We analyzed data of 273 CIN 3 HPV+ cases with abnormal cytology and HC2 persistence for 12+ months, were transferred to colposcopy. Histological assessment of minor and major changes was obligatory. The risk to miss CIN 3 is significantly increased in women with HPV persistency and normal cytology compared with patients who were transferred because of abnormal cytology.

Colposcopy failure was defined as any CIN3+ occurring after a colposcopy diagnosis of unless colposcopy images showed convincingly the development of new lesions in type 1 or 2 transformation zones. The cumulative CIN3+ prevalence was 0.96%.

While first colposcopy did not miss any out of 273 CIN3+ lesions with abnormal screening Pap smears, colposcopy failure was high (4,7%) in HC2+ women with normal cytology. Major reasons for the observed high colposcopy failure were failure of curettage in type 3 TZ, hiding of glandular lesions and lack of compliance.

Conclusions Colposcopy has a relevant impact on the performance of HPV screening and may benefit from new SOPs in the HPV- based German screening.

Publication History

Article published online:
11 October 2022