Advanced search

  • Ginekologia Polska
  • Vol 91, No 6 (2020) COLPOSCOPY 2020 — COLPOSCOPY PROTOCOLS: A Summary of the Clinical Experts Consensus Guidelines of the Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynaecologists and Obstetricians
Vol 91, No 6 (2020)
Guidelines / Expert consensus
Published online: 2020-06-30

open access

View PDF Download PDF file
Page views 2319
Article views/downloads 2026
Get Citation

Connect on Social Media

Connect on Social Media

COLPOSCOPY 2020 — COLPOSCOPY PROTOCOLS: A Summary of the Clinical Experts Consensus Guidelines of the Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynaecologists and Obstetricians

Robert Jach1, Maciej Mazurec2, Martyna Trzeszcz23, Anna Bartosinska-Dyc4, Barlomiej Galarowicz5, Witold Kedzia6, Andrzej Nowakowski7, Kazimierz Pitynski8
DOI: 10.5603/GP.2020.0075
Pubmed: 32627158
Ginekol Pol 2020;91(6):362371.

Abstract

The Polish Society of Colposcopy and Cervical Pathophysiology and the Polish Society of Gynecologists and Obstetricians provide comprehensive guidelines for colposcopy practice in secondary cervical cancer prevention in Poland. This part of the guidelines, developed by the clinical experts of the Working Group No. 1 (WG1), concerns the colposcopy protocols with the main aim of algorithmizing the procedure, together with all procedure-related processes. The detailed analysis of strong scientific evidence and an extensive literature review of current international colposcopic recommendations were carried out, with also a broad investigation of recently ongoing dynamic changes in national health systems. The attention to colposcopic limitations also occurring in Polish conditions was kept. The overriding goal was the recommended obligatory minimal colposcopy approach introduction. To enhance the standard of colposcopy, adjustment of a precolposcopic assessment, a performance technique, types of used biopsies, as well as the procedure documentation was made. Elements of the risk-based stratification for the increased risk of developing cervical cancer was also included if it was applicable for that part of the guidelines. Comprehensive colposcopy guidelines are a step towards the ongoing era of a precision medicine in cervical cancer prevention in Poland.

Keywords: colposcopycervical biopsycervical cancer preventioncolposcopic practiceguidelines

Article available in PDF format

View PDF Download PDF file

References

  1. Wentzensen N, Massad L, Mayeaux E, et al. Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States. Journal of Lower Genital Tract Disease. 2017; 21(4): 216–222.
    CrossRef
  2. Petry KU, Nieminen PJ, Leeson SC, et al. 2017 update of the European Federation for Colposcopy (EFC) performance standards for the practice of colposcopy. Eur J Obstet Gynecol Reprod Biol. 2018; 224: 137–141.
    CrossRefPubMed
  3. Cervical Cancer. PsycEXTRA Dataset. .
    CrossRef
  4. Solomon D, Schiffman M, Tarone R, et al. ALTS Study group. Comparison of three management strategies for patients with atypical squamous cells of undetermined significance: baseline results from a randomized trial. J Natl Cancer Inst. 2001; 93(4): 293–299.
    CrossRefPubMed
  5. Silver MI, Andrews J, Cooper CK, et al. Risk of Cervical Intraepithelial Neoplasia 2 or Worse by Cytology, Human Papillomavirus 16/18, and Colposcopy Impression: A Systematic Review and Meta-analysis. Obstet Gynecol. 2018; 132(3): 725–735.
    CrossRefPubMed
  6. Pretorius RG, Belinson JL, Burchette RJ, et al. Regardless of skill, performing more biopsies increases the sensitivity of colposcopy. J Low Genit Tract Dis. 2011; 15(3): 180–188.
    CrossRefPubMed
  7. Stoler M, Vichnin M, Ferenczy A, et al. The accuracy of colposcopic biopsy: Analyses from the placebo arm of the Gardasil clinical trials. International Journal of Cancer. 2011; 128(6): 1354–1362.
    CrossRef
  8. Huh W, Sideri M, Stoler M, et al. Relevance of Random Biopsy at the Transformation Zone When Colposcopy Is Negative. Obstetrics & Gynecology. 2014; 124(4): 670–678.
    CrossRef
  9. Pretorius RG, Belinson JL, Azizi F, et al. Utility of random cervical biopsy and endocervical curettage in a low-risk population. J Low Genit Tract Dis. 2012; 16(4): 333–338.
    CrossRefPubMed
  10. Aro K, Nieminen P, Louvanto K, et al. Age-specific HPV type distribution in high-grade cervical disease in screened and unvaccinated women. Gynecol Oncol. 2019; 154(2): 354–359.
    CrossRefPubMed
  11. Castle P, Adcock R, Cuzick J, et al. Relationships of p16 Immunohistochemistry and Other Biomarkers With Diagnoses of Cervical Abnormalities: Implications for LAST Terminology. Archives of Pathology & Laboratory Medicine. 2020; 144(6): 725–734.
    CrossRef
  12. Demarco M, Cheung LiC, Kinney WK, et al. Low Risk of Cervical Cancer/Precancer Among Most Women Under Surveillance Postcolposcopy. J Low Genit Tract Dis. 2018; 22(2): 97–103.
    CrossRefPubMed
  13. Curry S, Krist A, Owens D, et al. Screening for Cervical Cancer. JAMA. 2018; 320(7): 674.
    CrossRef
  14. Hastings JW, Alston MJ, Mazzoni SE, et al. Frequency of Adequate Endometrial Biopsy in Evaluation of Postmenopausal Women With Benign Endometrial Cells on Pap Test. J Low Genit Tract Dis. 2017; 21(4): 258–260.
    CrossRefPubMed
  15. Elfgren K, Elfström KM, Naucler P, et al. Management of women with human papillomavirus persistence: long-term follow-up of a randomized clinical trial. Am J Obstet Gynecol. 2017; 216(3): 264.e1–264.e7.
    CrossRefPubMed
  16. Wentzensen N, Schiffman M, Silver MI, et al. Evidence-Based Consensus Recommendations for Colposcopy Practice for Cervical Cancer Prevention in the United States. J Low Genit Tract Dis. 2017; 21(4): 216–222.
    CrossRefPubMed
  17. Arbyn M, Redman CWE, Verdoodt F, et al. Incomplete excision of cervical precancer as a predictor of treatment failure: a systematic review and meta-analysis. Lancet Oncol. 2017; 18(12): 1665–1679.
    CrossRefPubMed
  18. Wright TC, Stoler MH, Behrens CM, et al. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol. 2015; 136(2): 189–197.
    CrossRefPubMed
  19. Huh WK, Ault KA, Chelmow D, et al. Use of primary high-risk human papillomavirus testing for cervical cancer screening: interim clinical guidance. Obstet Gynecol. 2015; 125(2): 330–337.
    CrossRefPubMed
  20. Arbyn M, Snijders PJF, Meijer CJ, et al. Which high-risk HPV assays fulfil criteria for use in primary cervical cancer screening? Clin Microbiol Infect. 2015; 21(9): 817–826.
    CrossRefPubMed
  21. Zhao L, Wentzensen N, Zhang RR, et al. Factors associated with reduced accuracy in Papanicolaou tests for patients with invasive cervical cancer. Cancer Cytopathol. 2014; 122(9): 694–701.
    CrossRefPubMed
  22. Arbyn M, Roelens J, Simoens C, et al. Human papillomavirus testing versus repeat cytology for triage of minor cytological cervical lesions. Cochrane Database of Systematic Reviews. 2013.
    CrossRef
  23. Massad LS, Einstein MH, Huh WK, et al. 2012 ASCCP Consensus Guidelines Conference, 2012 ASCCP Consensus Guidelines Conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis. 2013; 17(5 Suppl 1): S1–S27.
    CrossRefPubMed
  24. Katki HA, Schiffman M, Castle PE, et al. Five-year risks of CIN 3+ and cervical cancer among women with HPV-positive and HPV-negative high-grade Pap results. J Low Genit Tract Dis. 2013; 17(5 Suppl 1): S50–S55.
    CrossRefPubMed
  25. Bergeron C, Ordi J, Schmidt D, et al. European CINtec Histology Study Group. Conjunctive p16INK4a testing significantly increases accuracy in diagnosing high-grade cervical intraepithelial neoplasia. Am J Clin Pathol. 2010; 133(3): 395–406.
    CrossRefPubMed
  26. Gage JC, Katki HA, Schiffman M, et al. The low risk of precancer after a screening result of human papillomavirus-negative/atypical squamous cells of undetermined significance papanicolaou and implications for clinical management. Cancer Cytopathol. 2014; 122(11): 842–850.
    CrossRefPubMed
  27. Fukuchi E, Fetterman B, Poitras N, et al. Risk of cervical precancer and cancer in women with cervical intraepithelial neoplasia grade 1 on endocervical curettage. J Low Genit Tract Dis. 2013; 17(3): 255–260.
    CrossRefPubMed
  28. Arbyn M, Ronco G, Anttila A, et al. Evidence Regarding Human Papillomavirus Testing in Secondary Prevention of Cervical Cancer. Vaccine. 2012; 30: F88–F99.
    CrossRef
  29. Mayeux EJ, Cox JT. Modern Colposcopy; Textbook and Atlas. 3rd ed. American Society for Colposcopy and Cervical Pathology; Wolters Kluwer. ; 2012 and 2014.
  30. Ronco G, Dillner J, Elfström K, et al. Efficacy of HPV-based screening for prevention of invasive cervical cancer: follow-up of four European randomised controlled trials. The Lancet. 2014; 383(9916): 524–532.
    CrossRef
  31. Wright TC, Behrens CM, Ranger-Moore J, et al. Triaging HPV-positive women with p16/Ki-67 dual-stained cytology: Results from a sub-study nested into the ATHENA trial. Gynecol Oncol. 2017; 144(1): 51–56.
    CrossRefPubMed
  32. Clarke MA, Cheung LiC, Castle PE, et al. Five-Year Risk of Cervical Precancer Following p16/Ki-67 Dual-Stain Triage of HPV-Positive Women. JAMA Oncol. 2019; 5(2): 181–186.
    CrossRefPubMed
  33. Ikenberg H, Bergeron C, Schmidt D, et al. Screening for Cervical Cancer Precursors With p16/Ki-67 Dual-Stained Cytology: Results of the PALMS Study. JNCI: Journal of the National Cancer Institute. 2013; 105(20): 1550–1557.
    CrossRef
  34. Benevolo M, Mancuso P, Allia E, et al. New Technologies for Cervical Cancer 2 Working Group. Interlaboratory concordance of p16/Ki-67 dual-staining interpretation in HPV-positive women in a screening population. Cancer Cytopathol. 2020; 128(5): 323–332.
    CrossRefPubMed
  35. Peeters E, Wentzensen N, Bergeron C, et al. Meta-analysis of the accuracy of p16 or p16/Ki-67 immunocytochemistry versus HPV testing for the detection of CIN2+/CIN3+ in triage of women with minor abnormal cytology. Cancer Cytopathol. 2019; 127(3): 169–180.
    CrossRefPubMed
  36. Tao X, Zhang H, Li J, et al. Prevalence of HPV-16/18 genotypes and immediate histopathologic correlation results in a Chinese population with negative cytology and positive high-risk HPV testing. Cancer Cytopathol. 2019; 127(10): 650–657.
    CrossRefPubMed
  37. Public Health England. NHS Cervical Screening Programme; Colposcopy and Programme Management. 3rd ed. 2019. https://www.gov.uk/government/publications/cervical-screening-programme-and-colposcopy-management (November 2019).
  38. Murphy J, Varela NP, Elit L, et al. The organization of colposcopy services in Ontario: recommended framework. Curr Oncol. 2015; 22(4): 287–296.
    CrossRefPubMed
  39. General Statistical Office. Health and a healthy lifestyle in a population of Poland. https://stat.gov.pl/obszary-tematyczne/zdrowie/zdrowie/zdrowie-i-zachowania-zdrowotne-mieszkancow-polski-w-swietle-badania-ehis-2014,10,1.html (November 2019).
  40. Spaczynski M, Kotarski J, Nowak-Markwitz E. Management of abnormal PAP smear – consensus guidelines of the National Cervical Cancer Screening Programme in Poland Coordinating Centre, the Polish Gynaecologic Society, the Polish Society of Pathologists and the Polish Society of Colposcopy and Uterine Cervix Pathology. Ginekol Pol. 2009; 80(2): 129–133.
  41. The national program of oncological diseases prevention. The program of a prophylaxis and an early detection of the cervical cancer. The responsibilities statement for year 2014. http://www.mz.gov.pl (April 2015).
  42. The national public program of a prophylaxis and an early detection of the cervical cancer. https://www.rakszyjki.org.pl (April 2015).
  43. Poręba R. Recommendations of the complex changes in the cancer of the uterine cervix prophylaxis in Poland. http://koalicjarsm.pl /rekomendacje.html (April 2015).
  44. Karsa Lv, Arbyn M, Vuyst HDe, et al. European guidelines for quality assurance in cervical cancer screening. Summary of the supplements on HPV screening and vaccination. Papillomavirus Research. 2015; 1: 22–31.
    CrossRef
  45. Nowakowski A, Cybulski M, Śliwczyński A, et al. The implementation of an organised cervical screening programme in Poland: an analysis of the adherence to European guidelines. BMC Cancer. 2015; 15: 279.
    CrossRefPubMed
  46. Canfell K, Kim JJ, Brisson M, et al. Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries. Lancet. 2020; 395(10224): 591–603.
    CrossRefPubMed
  47. Crum CP, Nucci MR, Lee KR. Diagnostic Gynecologic and Obstetric Pathology. 2nd ed. Philadelphia: Saunders. ; 2011.
  48. Luyten A, Buttmann-Schweiger N, Hagemann I, et al. German Colposcopy Network (G-CONE) and the German Colposcopy Study Group. Utility and Reproducibility of the International Federation for Cervical Pathology and Colposcopy Classification of Transformation Zones in Daily Practice: A Multicenter Study of the German Colposcopy Network. J Low Genit Tract Dis. 2015; 19(3): 185–188.
    CrossRefPubMed
  49. Clement PB, Young RH. Atlas of Gynecologic Surgical Pathology. 3rd ed Elsevier. ; 2014.
  50. Lamps LW. Diagnostic Pathology; Normal Histology. 1st ed. Canada: Amirsys. ; 2013.
  51. Brusselaers N, Shrestha S, Wijgert Jv, et al. Vaginal dysbiosis and the risk of human papillomavirus and cervical cancer: systematic review and meta-analysis. American Journal of Obstetrics and Gynecology. 2019; 221(1): 9–18.e8.
    CrossRef
  52. Jach R, Dulinska-Litewka J, Laidler P, et al. Expression of VEGF, VEGF-C and VEGFR-2 in in situ and invasive SCC of cervix. Front Biosci (Elite Ed). 2010; 2: 411–423.
    CrossRefPubMed
  53. Schiffman M, Wentzensen N. From Human Papillomavirus to Cervical Cancer. Obstetrics & Gynecology. 2010; 116(1): 177–185.
    CrossRef
  54. Schiffman M, Castle P, Jeronimo J, et al. Human papillomavirus and cervical cancer. The Lancet. 2007; 370(9590): 890–907.
    CrossRef
  55. Menárguez M, Pastor LM, Odeblad E. Morphological characterization of different human cervical mucus types using light and scanning electron microscopy. Hum Reprod. 2003; 18(9): 1782–1789.
    CrossRefPubMed
  56. Sellors JW, Sankaranarayanan R. An introduction to the anatomy of the uterine cervix. In:, editors. Colposcopy and treatment of cervical intraepithelial neoplasia: a beginners’ manual. Lyon: International Agency for Research and Cancer; https://screening.iarc.fr/colpochap.php?lang=1. 2003; 4(2019).
  57. Reich O, Regauer S, McCluggage WG, et al. Defining the Cervical Transformation Zone and Squamocolumnar Junction: Can We Reach a Common Colposcopic and Histologic Definition? Int J Gynecol Pathol. 2017; 36(6): 517–522.
    CrossRefPubMed
  58. Spinillo A, Gardella B, Iacobone AD, et al. Multiple Papillomavirus Infection and Size of Colposcopic Lesions Among Women With Cervical Intraepithelial Neoplasia. J Low Genit Tract Dis. 2016; 20(1): 22–25.
    CrossRefPubMed
  59. Practice Bulletin No. 140. Obstetrics & Gynecology. 2013; 122(6): 1338–1366.
    CrossRef
  60. Pretorius RG, Belinson JL, Burchette RJ, et al. Key Determinants of the Value of Random Cervical Biopsy at Colposcopy. J Low Genit Tract Dis. 2019; 23(4): 241–247.
    CrossRefPubMed
  61. Preventive Oncology International. 2018 . https://www.poiinc.org/resources/poi-microbiopsy-protocol-and-instrument/.
  62. Kurman RJ, Carcangiu ML, Herrington CS, et al. et al.. WHO Classification of Tumours; Female Genital Organ Tumours. 5th ed. Lyon: IARC. ; 2014.
  63. Darragh TM, Colgan TJ, Cox JT, et al. Members of LAST Project Work Groups. The Lower Anogenital Squamous Terminology Standardization Project for HPV-Associated Lesions: background and consensus recommendations from the College of American Pathologists and the American Society for Colposcopy and Cervical Pathology. Arch Pathol Lab Med. 2012; 136(10): 1266–1297.
    CrossRefPubMed
  64. Myriokefalitaki E, Redman CWE, Potdar N, et al. The Use of the Colposcopically Directed Punch Biopsy in Clinical Practice: A Survey of British Society of Colposcopy and Cervical Pathology (BSCCP)-Accredited Colposcopists. J Low Genit Tract Dis. 2016; 20(3): 234–238.
    CrossRefPubMed
  65. Pretorius RG, Zhang WH, Belinson JL, et al. Colposcopically directed biopsy, random cervical biopsy, and endocervical curettage in the diagnosis of cervical intraepithelial neoplasia II or worse. Am J Obstet Gynecol. 2004; 191(2): 430–434.
    CrossRefPubMed
  66. Wentzensen N, Walker J, Gold M, et al. Multiple Biopsies and Detection of Cervical Cancer Precursors at Colposcopy. Journal of Clinical Oncology. 2015; 33(1): 83–89.
    CrossRef
  67. Chen Q, Du H, Pretorius RG, et al. High-Grade Cervical Intraepithelial Neoplasia Detected by Colposcopy-Directed or Random Biopsy Relative to Age, Cytology, Human Papillomavirus 16, and Lesion Size. J Low Genit Tract Dis. 2016; 20(3): 207–212.
    CrossRefPubMed
  68. van der Marel J, Rodriguez A, Del Pino M, et al. The Value of Endocervical Curettage in Addition to Biopsies in Women Referred to Colposcopy. J Low Genit Tract Dis. 2015; 19(4): 282–287.
    CrossRefPubMed
  69. Pretorius RG, Belinson JL, Peterson P, et al. Which Colposcopies Should Include Endocervical Curettage? J Low Genit Tract Dis. 2015; 19(4): 278–281.
    CrossRefPubMed
  70. Milewicz A, Kudła M, Spaczyński RZ, et al. The polycystic ovary syndrome: a position statement from the Polish Society of Endocrinology, the Polish Society of Gynaecologists and Obstetricians, and the Polish Society of Gynaecological Endocrinology. Endokrynol Pol. 2018; 69(4).
    CrossRefPubMed
  71. Peron M, Llewellyn A, Moe-Byrne T, et al. Adjunctive colposcopy technologies for assessing suspected cervical abnormalities: systematic reviews and economic evaluation. Health Technol Assess. 2018; 22(54): 1–260.
    CrossRefPubMed
  72. Wade R, Spackman E, Corbett M, et al. Adjunctive colposcopy technologies for examination of the uterine cervix--DySIS, LuViva Advanced Cervical Scan and Niris Imaging System: a systematic review and economic evaluation. Health Technol Assess. 2013; 17(8): 1–240, v.
    CrossRefPubMed
  73. Hilal Z, Tempfer CB, Burgard L, et al. How long is too long? Application of acetic acid during colposcopy: a prospective study. Am J Obstet Gynecol. 2020 [Epub ahead of print].
    CrossRefPubMed
  74. Bornstein J, Bentley J, Bösze P, et al. 2011 colposcopic terminology of the International Federation for Cervical Pathology and Colposcopy. Obstet Gynecol. 2012; 120(1): 166–172.
    CrossRefPubMed
  75. Józefiak A, Kędzia W, Kotarski J, et al. Guidelines for application of molecular tests identyfying HR HPV DNA in the prevention of cervical cancer. Statement of experts from PGS (PTG) and NCLD (KIDL). Ginekol Pol. 2013 May. ; 84(5): 395–399.
  76. Nasierowska-Guttmejer A, Kędzia W, Wojtylak S, et al. Polish recommendations regarding diagnostics and treatment of cervical squamous intraepithelial lesions according to the CAP/ASCCP guidelines. Ginekologia Polska. 2016; 87(9): 676–682.
    CrossRef

About cookies

Necessary cookies

Allways active

These cookies are necessary for the proper display and operation of the website. Blocking them may cause the website to malfunction.

Analytical cookies

As part of our website, we use analytical tools, such as Google Analytics, that allow us to verify website traffic. These tools may require the use of cookies.

Community cookies

These are cookies associated with the social networks we use. Accepting them will allow us to associate your visit to the site with our social media profiles.

Marketing cookies

These are cookies responsible for carrying out advertising and marketing activities - consenting to their use will allow us to target you with advertisements based on your previous activities within our website.

Copyright © 2023-2024 Via Medica Regulations Cookie policy Privacy Statement Legal Note