Original Article Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program Ishita GHOSH, Srabani MITTAL, Dipanwita BANERJEE, Priyanka SINGH, Sujoy DASGUPTA, Simi CHATTERJEE, Jaydip BISWAS, Chinmay PANDA and Partha BASU Chittaranjan National Cancer Institute, Kolkata, India Objective: This population-based study was conducted to evaluate the performance of colposcopy to assess women with positive visual inspection with acetic acid (VIA) and/or human papillomavirus (HPV) tests. Materials and Methods: A total of 30 773 women were screened by VIA and oncogenic HPV test. Hybrid capture 2 was used for oncogenic HPV detection. All VIA- and/or HPV-positive women and 8.7% test-negative women had the colposcopy. International Federation of Cervical Pathology & Colposcopy (IFCPC) 2011 nomenclature was used for colposcopic classification of abnormalities. All women with grade 1 or worse lesions had punch biopsies. Biopsies were also obtained from HPV-positive women with normal colposcopy. Results: Colposcopy and satisfactory biopsy reports were available for total 2466 women. The overall strength of agreement between colposcopy and histologic classification of cervical neoplasias was poor (kappa = 0.17). Agreement was better when colposcopy was performed on HPV-positive women compared to VIA-positive women. Sensitivity of colposcopy to detect high-grade squamous intraepithelial lesions (HSIL) at referral threshold of grade 1 abnormality was 84.8% after correction of verification bias. Colposcopy was most inaccurate in identifying non-neoplastic conditions often encountered in VIA- and/or HPV-positive women. In 68.8% women with normal histology, colposcopic impression was grade 1 and above. Overestimation of disease severity on colposcopy was more common in VIA-positive women. Colposcopy also underestimated severity of disease in 52.6% of women with HSIL diagnosis on biopsy. Conclusions: Colposcopy performed well in the overall detection of cervical neoplasias, though its capability for accurate categorisation of degree of abnormality was poor. Key words: colposcopy, histopathology correlation, human papillomavirus, visual inspection with acetic acid. Introduction The strategies for cervical cancer screening are changing across the globe with the introduction of new screening techniques such as visual inspection after acetic acid application (VIA) and detection of human papillomavirus (HPV). 1,2 Optimisation of the precision of colposcopy is a major concern in the changing cervical cancer screening paradigms. 3 The new screening tests are superior to conventional cytology since they have higher sensitivity and better logistic convenience. However, the specificity of VIA is suboptimal and that of HPV DNA test can be considered mediocre at the best. 4,5 It has been observed earlier that a less specific screening test leads to high rate of false positives in subsequent colposcopy as well as histology of the screen-positive women. 6,7 Cytology provides some indication of the degree of abnormality to be expected at colposcopy, an advantage that neither of the other tests have. This makes colposcopic evaluation more challenging in VIA- and HPV-positive women. There is a need to assess the performance of colposcopy and to study the association between colposcopy and histology diagnoses in such noncytology-based screening programs. The present study evaluated the accuracy of colposcopy in a setting where women were screened using VIA and HPV DNA test. The degree of agreement between colposcopic impression and cervical histopathology was assessed in women investigated for abnormal VIA and/or HPV test. Materials and Methods The study was conducted in women screened for cervical cancer in a community-based program of Chittaranjan Correspondence: Associate Professor Partha Basu, Department of Gynecologic Oncology (Head), Chittaranjan National Cancer Institute, 37, S. P. Mukherjee Road, Kolkata 700026, India. Email: basupartha@hotmail.com Received 7 July 2014; accepted 4 October 2014. 570 © 2014 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists Australian and New Zealand Journal of Obstetrics and Gynaecology 2014; 54: 570–575 DOI: 10.1111/ajo.12282 he Australian and New Zealand Journal of Obstetrics and Gynaecology