Currently, for early cervical cancer and precancerous lesions, the recommended diagnostic method is the “three-step” method, Cytology C Colposcopy CHistology ( CCH
), i.e. cytology-colposcopy-histopathology. This is sufficient to diagnose about 80% of cases, but how to diagnose the remaining 20%? The “four-step approach” to diagnose cervical disease, i.e., one question, two looks, three touches, and four diagnoses, has the following main elements: One question: ask the patient’s history carefully. The second look is to see the appearance of the cervix, the degree and type of “erosion”, the size of the metaplasia zone, and the preliminary determination of the type of transformation zone; the third touch is to feel the texture of the cervix, and the preliminary measurement of the size of the cervix; the fourth diagnosis is to use two guns, i.e. cytology in the left hand (plus the modern HPV test). The fourth diagnosis is the use of two guns, namely cytology (plus modern HPV testing) in the left hand and colposcopy in the right hand, to assist in the diagnosis of cervical lesions with the help of these magnified “eyes”. The “four-step approach” emphasizes the role of history taking and gynecologic examination in diagnosis, as both cytology and colposcopy have their limitations, and it would be misleading to magnify the efficacy of their tests. Currently, the positive detection rate for cytology is up to 80% in world class laboratories with top cytopathologists conducting the work. What is the diagnostic accuracy of colposcopy? Prior to colposcopy, further examination of abnormal cytology was performed by multi-point biopsy or/and cervical canal scraping, and if the diagnosis was still not clear, diagnostic conization was performed. The promotion and application of colposcopy technology has increased the diagnostic rate of cervical epithelial neoplasia and early cervical cancer, and most cases can be diagnosed colposcopically, resulting in a significant decrease in diagnostic conization procedures, which have been replaced by colposcopy and microscopic biopsy. However, when we take a closer look, we found that colposcopic pathological diagnosis compared with that of cone specimens, about 16.7% – 22.2% of the patients were diagnosed with colposcopic biopsy.
The pathological diagnosis of colposcopic biopsy is lighter than the diagnosis of cervical conization in about 16.7 – 22.2% of patients. Most experts agree that colposcopy and multi-point microscopic cervical biopsy cannot completely replace diagnostic cervical conization.