Could Clinically Suspicious Cervix Predict Cervical Premalignant and Malignant Lesions in Postmenopausal Women?

Purpose: Assessing the role of clinically suspicious cervix in detecting premalignant and malignant lesions in postmenopausal women, ndependent of cervical cytology and human papilloma virus (HPV)-deoxyribonucleic acid (DNA) testing.Methods: This study retrospectively analyzed 392 postmenopausal women aged 45-86 who underwent colposcopic biopsy at our clinic between 2017 and 2021.Data collected included patient age, parity, cervical cytology results, HPV-DNA test outcomes, and colposcopic biopsy findings.Patients were categorized based on the indication for colposcopy into three groups: clinically suspicious cervix, high-risk group HPV-DNA positivity, and abnormal cytology.The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting premalignant and malignant cervical lesions were subsequently calculated.Results: Among the 174 patients referred for colposcopic biopsy due to a clinically suspicious cervix, 50% were found to have cervical premalignant lesions classified as cervical intraepithelial neoplasia-1 or higher, and 10% were diagnosed with malignancy.In the subset of 30 patients aged 65 and older with a clinically suspicious cervix, 17 were diagnosed with either premalignant or malignant cervical lesions.The sensitivities of clinically suspicious cervix, HPV-DNA positivity, and abnormal cytology for detecting premalignant or malignant lesions were 43%, 80%, and 37%, respectively.The specificities were 53%, 49%, and 73%; accuracies were 47%, 67%, and 51%; PPV were 60%, 68%, and 69%; and NPV were 36%, 64%, and 42%, respectively.Additionally, among the 392 patients, 11 were diagnosed with premalignant or malignant lesions solely through endocervical curettage. Conclusion:The presence of a clinically suspicious cervix serves as a significant indication for colposcopy, comparable to traditional screening tests, in the detection of cervical premalignant and malignant lesions.The findings from our study indicate that cervical cancer screening should be maintained in women over the age of 65.