Gynecologic Oncology Reports 34 (2020) 100661 Available online 24 October 2020 2352-5789/© 2020 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Case series Colposcopy accuracy in diagnosing cervical precancerous lesions in western Kazakhstan Saule Balmagambetova a, * , Andrea Tinelli d , Olzhas Urazayev a , Arip Koyshybaev a , Elnara Ismagulova b , Kanshaiym Sakiyeva c , Saganaj Djussembekov a , Dinara Zholmukhamedova a a Department of Oncology, West Kazakhstan Marat Ospanov Medical University, 030019, 68, Maresyev Street, Aktobe, Kazakhstan b ENT Diseases Department, West Kazakhstan Marat Ospanov Medical University, 030019, 68, Maresyev Street, Aktobe, Kazakhstan c Department of Obstetrics and Gynecology, West Kazakhstan Marat Ospanov Medical University, 030019, 68, Maresyev Street, Aktobe, Kazakhstan d Laboratory of Human Physiology, Phystech Biomed School, Faculty of Biological & Medical Physics, Moscow Institute of Physics and Technology (State University), 9, Institutskiy Lane, 141701 Dolgoprudny, Moscow Region, Russia A R T I C L E INFO Keywords: Human papillomavirus Reid colposcopy index Cytology Screening Kazakhstan ABSTRACT This retrospective cohort study focused on colposcopic accuracy for the diagnosis of cervical premalignant le- sions using cytology and histology, as well as HPV data not included in current cervical screening practices in Kazakhstan. Colposcopy performance was assessed using the modifed Reid index in women aged 18–63 years. In total, 1,129 colposcopic-HPV-cytology triple samples and 94 histology fndings were collected. The sensitivity of colposcopy was 81.6% with specifcity 72.6% for LSIL but fell to 56.6% with specifcity 88.3% for CIN2+ vs. 89.6% and 74.5% for cytology at CIN2+, respectively. The ORs for high-grade lesion occurrence within each colposcopy group at viral load rising vs. ORs for HPV-negative women were 3.4; 5.3; and 39.7, respectively (p < 0.0001). Total attributive agreement between the colposcopy and histology fndings reached 55.3%, κ 0.47 ± 0.06 vs. 0.62 ± 0.08 for cytology, and 0.34 ± 0.13 and 0.58 ± 0.1, for specialists, respectively. Outcomes ob- tained for colposcopy alone failed to show satisfactory reliability. Globally adopted primary HPV screening would be the best option despite the related costs. 1. Introduction Cervical cancer (CC) is caused by the group of human papillomavi- ruses (HPV) for which “there is no perfect way to categorize a continuum of their carcinogenic potential” (Schiffman et al., 2009). In Kazakhstan, a sizeable post-Soviet state in Central Asia, the nationwide CC screening program was implemented in 2008; nevertheless, issues of cancer pre- vention remain problematic. The screening program includes a Pap test every four years in women aged 30–70 years old using liquid-based cytology (LBC) techniques with “Cell Scan” technology (South Korea manufacturing) and conventional azur-eosin staining as an opportu- nistic method. In research, the conventional azur-eosin method had a sensitivity of 90.4% and a specifcity of 90.0% for CIN2+. Researchers failed to show the LBC “Cell Scan” technique to be superior to simple azur-eosin staining (Balmagambetova et al., 2020). Primary HPV testing accompanied by cytology triage in HPV-positive women aged 30+ has not been adopted in the country, despite the HPV prevalence of approximately 25–28% (Aimagambetova and Azizan, 2018). Report- edly, the CC incidence rate was 18.2 per 100,000 women in Kazakhstan (Bruni et al., 2019). According to commonly accepted guidelines, colposcopy examina- tion follows screening procedures upon presentation of abnormal cytology (Boardman et al., 2019; NHS Cervical Screening Programme, 2016). Regarding the diagnostic accuracy of colposcopy in various meta- analyses, its sensitivity fuctuated from 29% to 100%, and its specifcity ranged from 12% to 88% (Mustafa et al., 2016). At least a rough analysis of colposcopy capabilities for screening purposes would be reasonable given the HPV testing unavailability in the country. In this study, we assessed colposcopy accuracy for the diagnosis of cervical precancer lesions compared to cytology and histology fndings * Corresponding author. E-mail addresses: sau3567@gmail.com (S. Balmagambetova), andreatinelli@gmail.com (A. Tinelli), u_olzhas@mail.ru (O. Urazayev), arip_koish@mail.ru (A. Koyshybaev), ismagulova_e@mail.ru (E. Ismagulova), sakieva.k@mail.ru (K. Sakiyeva), saga54@list.ru (S. Djussembekov), dinok_245@mail.ru (D. Zholmukhamedova). Contents lists available at ScienceDirect Gynecologic Oncology Reports journal homepage: www.elsevier.com/locate/gynor https://doi.org/10.1016/j.gore.2020.100661 Received 13 July 2020; Received in revised form 15 October 2020; Accepted 18 October 2020