Optimizing the Detection of Occult Cervical Cancer: A Prospective Multicentre Study in China

Figures & data

Figure 1 Clinical characteristics of the enrolled patients. (A) Age distribution. (B) Cytology result. (C) HPV infection status. (D) Distribution of transformation zone type.

Abbreviations: NILM, negative for intraepithelial lesion or malignancy; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; ASC-H, atypical squamous cells, cannot exclude HSIL; HSIL, high-grade squamous intraepithelial lesion; AGC, atypical glandular cells; HR-HPV, high-risk human papillomavirus; LR-HPV, low-risk human papillomavirus; NC, not classified; NP, not performed; TZ, transformation zone.

Table 1 Correlation Between Colposcopy Impression, CDB&ECC and Conization

		Histopathological Diagnosis of Conization							Total
		Normal	Inflammation	LSIL	HSIL	IA1	IA2	IB1
Colposcopy Impression	Normal	0	1	0	0	0	0	0	1
	Inflammation	0	9	7	57	0	0	0	73
	LSIL	1	17	24	126	1	0	1	170
	HSIL	1	85	130	803	26	1	2	1048
	Cancer	0	0	0	5	1	0	0	6
	Total	2	112	161	991	28	1	3	1298
CDB&ECC	Normal	1	2	0	1	0	0	0	4
	Inflammation	0	4	3	39	0	0	0	46
	LSIL	0	11	37	46	0	0	0	94
	HSIL	1	94	113	839	17	1	2	1067
	MIC	0	0	1	7	8	0	0	16
	Cancer	0	0	0	1	0	0	1	2
	Total	2	111	154	933	25	1	3	1229

Note: IA1, IA2, IB1, cervical cancer staging based on FIGO 2018.

Abbreviations: LSIL, low-grade squamous intraepithelial lesion; HSIL, high-grade squamous intraepithelial lesion; MIC, microinvasive cancer; CDB, colposcopy-directed biopsy; ECC, endocervical curettage.

Table 2 Diagnostic Value of Cytology Under Different Criteria in Detecting Pathologic Cervical Cancer

Cytology Cut-Off	Sensitivity	Specificity	Youden Index	Cohen’s κ Coefficient
ASC-US+	66.67%	29.18%	−0.042	−0.004 (P=0.562)
LSIL+	50.00%	52.66%	0.027	0.004 (P=0.735)
ASC-H+	45.24%	68.44%	0.137	0.030 (P=0.063)
HSIL+	30.95%	80.13%	0.111	0.036 (P=0.080)
Cancer	4.76%	99.71%	0.045	0.078 (P=0.014)

Abbreviations: ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; ASC-H, atypical squamous cells, cannot exclude HSIL; HSIL, high-grade squamous intraepithelial lesion.

Table 3 Detailed Results of the “Three-Step” Screening Procedure of Occult Cervical Cancer Patients

NO.	Cytology	HPV	Colposcopy	CDB&ECC	TZ Type	Length of Cervix (cm)	Length of Cervical Cone Excision (cm)	Conization Histopathology	FIGO Stage
1	NILM	16	HSIL	HSIL	1	1.3	0.8	MIC	IA1
2	NILM	18	HSIL	HSIL	2	1.2	0.7	MIC	IA1
3	NILM	16	HSIL	HSIL	3	1.5	0.7	MIC	IA1
4	NILM	16	HSIL	HSIL	3	1.5	0.8	MIC	IA1
5	NILM	16	HSIL	HSIL	3	1.5	0.8	MIC	IA1
6	ASC-US	18	HSIL	HSIL	3	1.3	0.8	MIC	IA1
7	ASC-US	16,18	HSIL	HSIL	3	1.0	0.9	MIC	IA1
8	LSIL	16,53	HSIL	HSIL	3	1.3	0.8	MIC	IA1
9	ASC-H	16	HSIL	HSIL	1	1.5	0.9	MIC	IA1
10	ASC-H	28	HSIL	HSIL	3	1.2	0.7	MIC	IA1
11	ASC-H	33,58	HSIL	HSIL	3	3.7	1.9	MIC	IA1
12	HSIL	35	HSIL	HSIL	1	1.3	0.8	MIC	IA1
13	HSIL	16,58	HSIL	HSIL	3	1.5	1.0	MIC	IA1
14	HSIL	16	LSIL	HSIL	3	1.5	0.8	MIC	IA1
15	HSIL	35	HSIL	HSIL	3	1.4	0.8	MIC	IA1
16	HSIL	33	Cancer	HSIL	3	1.5	0.7	MIC	IA1
17	HSIL	33	HSIL	HSIL	1	3.8	1.5	MIC	IA1
18	Cancer	16	Cancer	HSIL	3	3.4	2.0	MIC	IA1
19	NILM	16,39	LSIL	HSIL	3	4.4	1.8	IC	IB1
20	ASC-US	18,33	HSIL	HSIL	3	2.6	1.8	IC	IB1

Note: IA1, IB1, cervical cancer staging based on FIGO 2018.

Abbreviations: NILM, negative for intraepithelial lesion or malignancy; ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; ASC-H, atypical squamous cells, cannot exclude HSIL; HSIL, high-grade squamous intraepithelial lesion; HPV, human papillomavirus; CDB, colposcopy-directed biopsy; ECC, endocervical curettage; TZ, transformation zone; MIC, microinvasive cancer; IC, invasive cancer; FIGO, International Federation of Gynecology and Obstetrics.

Figure 2 Binary logistic regression results to identify risk factors for HSIL+ patients.

Abbreviations: ASC-US, atypical squamous cells of undetermined significance; LSIL, low-grade squamous intraepithelial lesion; ASC-H, atypical squamous cells, cannot exclude HSIL; HSIL, high-grade squamous intraepithelial lesion; AGC, atypical glandular cells; HPV, human papillomavirus; CDB, colposcopy-directed biopsy; ECC, endocervical curettage; TZ, transformation zone.

Figure 3 (A) Distribution of the transformation zone in patients with different grades of cervical lesions. (B) Difference in length proportion of cervical cone excision between cervical cancer patients and HSIL patients. *Significant difference between two groups (P < 0.05). (C) ROC curve of the length proportion of cervical cone excision in detecting cervical cancer.

Abbreviations: HSIL, high-grade squamous intraepithelial lesion; LSIL, low-grade squamous intraepithelial lesion; TZ, transformation zone.