Immediate referral to colposcopy versus cytological surveillance for minor cervical cytological abnormalities in the absence of HPV test

Immediate colposcopy for minor cervical cytological abnormalities in the absence of HPV test, appears to detect earlier high-grade lesions, at the cost of more clinically insignificant low-grade lesions. The detection rate of cervical intra-epithelial lesion, CIN2+ or CIN3+ after 2 years does not appear to differ between immediate colposcopy and cytological surveillance.

Comment: The quality of evidence is downgraded by inconsistency (unexplained heterogeneity in results).

Summary

A Cochrane review included 5 studies with a total of 11 466 subjects. There were 18 cases of invasive cervical cancer, 7 in the immediate colposcopy and 11 in the cytological surveillance groups, respectively. Although immediate colposcopy detects cervical intra-epithelial lesion, CIN2+ and CIN3+ earlier than cytology, the differences were no longer observed at 24 months (table ). The inter-study heterogeneity was considerable (I² over 90%). When the exit examination was excluded, the detection rate of high-grade lesions at the 18-month follow-up was higher after immediate colposcopy, both had substantial inter-study heterogeneity (I² over 60%). Immediate referral to colposcopy significantly increased the detection of clinically insignificant cervical abnormalities, as opposed to repeat cytology after 24 months of surveillance, incidence of any CIN (64% versus 32%, RR 2.02, 95% CI 1.33 to 3.083; 2 studies, n=656 women; low quality evidence), and incidence of CIN1. The risk for default was higher for the repeat cytology group, with a 4-fold increase at 6 months, a 6-fold at 12 and a 19-fold at 24 months (table ).

Clinical comments

Date of latest search: 21 April 2016

Ədəbiyyat

1. Kyrgiou M, Kalliala IE, Mitra A et al. Immediate referral to colposcopy versus cytological surveillance for minor cervical cytological abnormalities in the absence of HPV test. Cochrane Database Syst Rev 2017;(1):CD009836.