The accuracy of colposcopic grading for detection of high-grade cervical intraepithelial neoplasia

L. Stewart Massad, Jose Jeronimo, Hormuzd A. Katki, Mark Schiffman, Sameer Antani, Lori Boardman, Peter Cartwright, Philip Castle, Charles Dunton, Julia Gage, Richard Guido, Fernando Guijon, Thomas Herzog, Warner Huh, Abner Korn, Edward Kost, Ramey D. Littell, Rodney Long, Jorge Morales, Leif NeveDennis O'Connor, Janet S. Rader, George Sawaya, Mario Sideri, Karen Smith-McCune, Mark Spitzer, Alan Waxman, Claudia Werner

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


OBJECTIVE. To relate aspects of online colposcopic image assessment to the diagnosis of grades 2 and 3 cervical intraepithelial neoplasia (CIN 2+). METHODS. To simulate colposcopic assessment, we obtained digitized cervical images at enrollment after acetic acid application from 919 women referred for equivocal or minor cytologic abnormalities into the ASCUS-LSIL Triage Study. For each, 2 randomly assigned evaluators from a pool of 20 colposcopists assessed images using a standardized tool online. We calculated the accuracy of these assessments for predicting histologic CIN 2+ over the 2 years of study. For validation, a subset of online results was compared with same-day enrollment colposcopic assessments. RESULTS. Identifying any acetowhite lesion in images yielded high sensitivity: 93% of women with CIN 2+ had at least 1 acetowhite lesion. However, 74% of women without CIN 2+ also had acetowhitening, regardless of human papillomavirus status. The sensitivity for CIN 2+ of an online colpophotographic assessment of high-grade disease was 39%. The sensitivity for CIN 2+ of a high-grade diagnosis by Reid Index scoring was 30%, and individual Reid Index component scores had similar levels of sensitivity and specificity. The performance of online assessment was not meaningfully different from that of same-day enrollment colposcopy, suggesting that these approaches have similar utility. CONCLUSIONS. Finding acetowhite lesions identifies women with CIN 2+, but using subtler colposcopic characteristics to grade lesions is insensitive. All acetowhite lesions should be assessed with biopsy to maximize sensitivity of colposcopic diagnosis with good specificity.

Original languageEnglish
Pages (from-to)137-144
Number of pages8
JournalJournal of lower genital tract disease
Issue number3
StatePublished - Jul 2009


  • Acetowhite lesion
  • Biopsy
  • Cervical intraepithelial neoplasia
  • Colposcopy
  • Pap test


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