Risk-Based Colposcopy for Cervical Precancer Detection: A Cross-Sectional Multicenter Study in China

Abstract

Recently published guidelines depend upon screening for cervical precancer risk stratification; however, colposcopy provides key information. There is no data from developing countries that could be used comparatively. Therefore, we assessed the potential benefits of intercalating colposcopic impressions with screening results to detect cervical precancers through a multicenter, cross-sectional study of a Chinese population. Anonymized data from 6012 women with cytologic assessment, human papillomavirus (HPV) testing, colposcopic impressions, and histological results were analyzed. Univariate and multivariate analysis showed that high-grade squamous intraepithelial lesion (HSIL) cytology, HPV16/18+, and/or high-grade colposcopic impressions markedly increased cervical precancer risk, while high-grade colposcopic impressions were associated with the highest risk. The risk of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) ranged from 0% for normal/benign colposcopic impressions, <HSIL cytologies, and HPV negative to 63.61% for high-grade colposcopy, HSIL+ cytology, and HPV16/18+, across 18 subgroups. High-grade colposcopic impressions were associated with a >19% increased risk of CIN3+, even in participants without HSIL+ cytology and/or HPV16/18+. Regardless of screening outcomes, normal/benign colposcopic impressions were associated with the lowest risk of CIN3+ (<0.5%). Integrating colposcopic impressions into risk assessment may therefore provide key information for identifying cervical precancer cases. Adopting this approach may improve detection rates while also providing reassurance for women with a lower risk of developing cervical cancer.