Effects of Adherence to Colposcopy Guidelines on the Detection of Cervical Intraepithelial Neoplasia.

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

Journal of Lower Genital Tract Disease Pub Date : 2025-10-13 DOI:10.1097/LGT.0000000000000918

Jessica R Fine, Claire M Bartel, Simone T Conde, Badr A Abdullah, Felicia L Hamilton

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引用次数: 0

Abstract

Objectives: Practice recommendations for the minimum steps to perform a colposcopy were published in 2017. The goals of this study are to assess if adherence to these guidelines correlates with detection of cervical intraepithelial neoplasia and to analyze factors associated with rates of biopsy during colposcopy.

Materials and methods: All colposcopies performed at 2 academic medical centers between 2018-2023 were identified by billing code. Patient demographics, cervical cancer screening, medical history, colposcopy details, and pathology were collected from retrospective medical record review. Adherence to guidelines was determined by the number of criteria met on colposcopy documentation. The outcomes assessed were grade of pathology and rate of biopsy.

Results: In univariable regression analysis, no association between adherence to guidelines and detection of cervical intraepithelial neoplasia 2+ was identified (odds ratio [OR] = 1.11, p = .12). When controlling for race, ethnicity, insurance type, Pap test cytology, and human papillomavirus vaccination status in multivariate analysis, there remained no statistically significant correlation (adj. OR = 1.11, p = .14).Black patients (OR = 0.66, p = .039), publicly insured patients (OR = 0.38, p < .001), and patients with HIV (OR = 0.39, p < .001) were each significantly less likely to have a biopsy taken during colposcopies compared to White, privately insured patients, or HIV-negative patients. In multivariate analysis, HIV and public insurance remained factors associated with lower rates of biopsy (adj. OR = 0.46, p < .001 and adj. OR = 0.63, p = .035, respectively).

Conclusions: The study found insufficient evidence to support current colposcopy guidelines. The analysis revealed disparities in the execution of biopsies during colposcopies, particularly in Black, publicly insured, and HIV-positive patients, underscoring the importance of standardization of colposcopic practices.

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遵守阴道镜检查指南对宫颈上皮内瘤变检测的影响。

目的：关于阴道镜检查最低步骤的实践建议于2017年发布。本研究的目的是评估遵守这些指南是否与宫颈上皮内瘤变的检测相关，并分析与阴道镜检查活检率相关的因素。材料和方法：2018-2023年间在2个学术医疗中心进行的所有阴道镜检查均通过账单代码进行识别。患者人口统计资料、宫颈癌筛查、病史、阴道镜检查细节和病理资料均来自回顾性病历回顾。对指南的遵守取决于阴道镜检查文件中符合标准的数量。评估的结果是病理分级和活检率。结果：在单变量回归分析中，未发现遵守指南与宫颈上皮内瘤变2+的检测之间存在关联（优势比[OR] = 1.11, p = .12）。当在多变量分析中控制种族、民族、保险类型、巴氏试验细胞学和人乳头瘤病毒疫苗接种情况时，仍然没有统计学上显著的相关性（OR = 1.11, p = 0.14）。黑人患者（OR = 0.66, p = 0.039）、公共保险患者（OR = 0.38, p < .001）和艾滋病毒患者（OR = 0.39, p < .001）在阴道镜检查中进行活检的可能性均显著低于白人、私人保险患者或HIV阴性患者。在多变量分析中，HIV和公共保险仍然是与低活检率相关的因素（分别为OR = 0.46, p < 0.001和OR = 0.63, p = 0.035）。结论：该研究没有足够的证据支持目前的阴道镜检查指南。该分析揭示了阴道镜检查中活检执行的差异，特别是在黑人、公共保险和hiv阳性患者中，强调了阴道镜检查标准化的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Lower Genital Tract Disease OBSTETRICS & GYNECOLOGY-

CiteScore

6.80

自引率

8.10%

发文量

158

审稿时长

6-12 weeks

期刊介绍： The Journal of Lower Genital Tract Disease is the source for the latest science about benign and malignant conditions of the cervix, vagina, vulva, and anus. The Journal publishes peer-reviewed original research original research that addresses prevalence, causes, mechanisms, diagnosis, course, treatment, and prevention of lower genital tract disease. We publish clinical guidelines, position papers, cost-effectiveness analyses, narrative reviews, and systematic reviews, including meta-analyses. We also publish papers about research and reporting methods, opinions about controversial medical issues. Of particular note, we encourage material in any of the above mentioned categories that is related to improving patient care, avoiding medical errors, and comparative effectiveness research. We encourage publication of evidence-based guidelines, diagnostic and therapeutic algorithms, and decision aids. Original research and reviews may be sub-classified according to topic: cervix and HPV, vulva and vagina, perianal and anal, basic science, and education and learning. The scope and readership of the journal extend to several disciplines: gynecology, internal medicine, family practice, dermatology, physical therapy, pathology, sociology, psychology, anthropology, sex therapy, and pharmacology. The Journal of Lower Genital Tract Disease highlights needs for future research, and enhances health care. The Journal of Lower Genital Tract Disease is the official journal of the American Society for Colposcopy and Cervical Pathology, the International Society for the Study of Vulvovaginal Disease, and the International Federation of Cervical Pathology and Colposcopy, and sponsored by the Australian Society for Colposcopy and Cervical Pathology and the Society of Canadian Colposcopists.