Endocervicoscopy: a new technique for the diagnostic work-up of cervical intraepithelial neoplasia allowing a tailored excisional therapy in young fertile women.

OBJECTIVE

To propose and validate endocervicoscopy, a new technique for patients with high-grade squamous intraepithelial lesion and unsatisfactory or negative colposcopy.

DESIGN

Prospective trial.

SETTING

Department of Obstetrics, Gynaecology and Pathophysiology of Human Reproduction University of Naples Federico II.

PATIENT(S): Ninety-five consecutive patients with repeatedly positive cervicovaginal cytology for high-grade squamous intraepithelial lesion and negative or unsatisfactory colposcopy.

INTERVENTION(S): Endoscopic evaluation of the endocervical mucosa, performed with an office continuous-flow hysteroscope after application of acetic acid 5% (endocervicoscopy). Patients diagnosed with abnormal cervical findings (group A) underwent targeted biopsies of the visualized abnormalities. Negative patients at endocervicoscopy (group B) underwent blind curettage of the endocervix. Eventually, both groups underwent a cold knife conization.

MAIN OUTCOME MEASURE(S): Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of endocervicoscopy plus targeted biopsy and curettage, compared with the reference test, represented by surgical specimen of cervical conization.

RESULT(S): Endocervicoscopy plus targeted biopsy showed a sensitivity of 79%, a specificity of 100%, a diagnostic accuracy of 80%, a PPV of 99%, and a NPV of 51%. The volume of cone biopsy of patients from group A was significantly smaller than that of group B (3.03 ± 0.61 mL vs. group B: 4.07 ± 0.24 mL).

CONCLUSION(S): Endocervicoscopy appears to be a safe and effective office technique, improving the diagnostic work-up of cervical intraepithelial lesions. The precise localization of the lesions allows for the depth of cone excision to be tailored, thus leading to a more conservative treatment and preserving the future fertility of women.