Diagnostic Concordance of Colposcopic Impression, Colposcopic Directed Biopsy and Final Excisional Biopsy Among Women Who Have Undergone Loop Electrosurgical Excision Procedure for Precancerous Cervical Lesions at Kenyatta National Hospital Between 2013-2022

Abstract

BACKGROUND A crucial part of preventing cervical cancer is the timely diagnosis and appropriate treatment of women with precancerous lesions of the cervix. These lesions are evaluated via colposcopic visual examination of the cervix before being treated, either by excision or ablation. An essential facet of colposcopic practice is the colposcopically directed biopsy (CDB), which allows lesions to be graded histologically before treatment using loop electrosurgical excision procedure (LEEP). Agreement of the colposcopic impression, CDB and final excisional biopsy obtained from LEEP is essential to avoid overtreatment and undertreatment. By understanding the level of concordance, we can identify areas where improvements are necessary to provide patients with the most effective interventions based on accurate diagnoses. BROAD OBJECTIVE To evaluate the diagnostic concordance of colposcopic impression, CDB and final excisional biopsy among women who have undergone LEEP as a treatment for precancerous cervical lesions in Kenyatta National Hospital (KNH), 2013-2022 METHODS This was a retrospective descriptive cohort study using routinely collected data. Women who underwent LEEP as the treatment for cervical intraepithelial neoplasia (CIN) at KNH between 2013 and 2022 were included in the study. Data were retrieved from files with complete CDB and LEEP histology information during the study period, entered into MS Excel and analysed using Stata version 18. The mean and standard deviation for continuous data and the frequency distribution for categorical variables were calculated to conduct a descriptive analysis of sociodemographic and clinical characteristics. The primary analysis used percentages to evaluate the diagnostic concordance between the colposcopic impression, CDB histology and final excisional histology, with LEEP biopsy as the gold standard for treating precancerous cervical lesions. The secondary analysis used univariate analyses to determine the correlation of sociodemographic and clinical characteristics with the colposcopic impression, CDB and LEEP histologies.