Clinical application of the 2011 IFCPC colposcope terminology in the era of HPV vaccines

Abstract Background Colposcopy is the conjunction with screening and diagnosis of cervical precancerous lesions. However the diagnostic accuracy of colposcopy is unsatisfied. This study was to evaluate colposcopic accuracy according to the 2011 International Federation of Cervical Pathology and Colposcopy (IFCPC) terminology.Methods A retrospective cohort study was performed in 1,838 patients who underwent colposcopy in Shandong Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University from October 2013 to April 2018. Using conization or cervical biopsy pathology as the gold standard, the agreement between colposcopic diagnosis and pathologic diagnosis was calculated, and correlations between variables were analyzed. Results As an authoritative and widely used terminology for colposcopy diagnosis, the 2011 IFCPC terminology has certain clinical practicality and diagnostic accuracy. However, some signs such as mosaic, punctuation, sharp border, inner border sign and ridge sign had high specificity but unsatisfactory sensitivity, which limited the diagnostic value. Therefore, we discussed the Lugol’s staining, a very common sign in colposcopy, and analyzed the diagnostic significance of bright yellow staining in low-grade squamous intraepithelial lesion (LSIL) and mustard yellow staining in high-grade squamous intraepithelial lesion (HSIL). The results showed that mustard yellow may be a valuable indicator in the diagnosis of HSIL. Conclusion With the wide acceptance of human papilloma virus (HPV) vaccines and HPV-based screening, there will be new challenges to accurately identify the signs of non-HPV16 and non-HPV18 infections and of minor lesions using colposcopy. In this study, we provide some recommendations in dealing with these challenges. More clinical research will be needed to further refine colposcopy terminology, improve diagnostic accuracy, and ensure that the World Health Organization’s goal of eliminating cervical cancer worldwide by 2030 is achieved.