Factors Associated with Concordance between Colposcopy-Directed Cervical Biopsy and Loop Electrosurgical Excision Procedure: A Retrospective Cohort Study

Background: Colposcopy-directed cervical biopsy (CDB) is the most commonly used diagnostic method for the detection of cervical precancerous lesions, while the loop electrosurgical excision procedure (LEEP) is the most common surgical technique for treatment. However, discrepancies between CDB and LEEP results have been reported in the literature. Therefore, identifying the factors that influence concordance between these two procedures is crucial for accurately diagnosing precancerous lesions and preventing over- and under-treatment. Methods: A retrospective analysis was conducted on women who underwent conization between January 2015 and December 2023 due to a preoperative CDB revealing lesions classified as ≥ cervical intraepithelial neoplasia 2 (CIN2+), including CIN 2, CIN3, and invasive cancer. Demographic data, along with colposcopy and conization results, were obtained from patient records and the electronic gynecologic oncology clinic database. Results: A total of 358 patients were included in the analysis. The overall concordance between CDB and LEEP pathology was 68.7% (n = 246/358). In the univariate analysis, age, menopausal status, and endocervical curettage (ECC) result were identified as factors associated with concordance between CDB and LEEP result (p = 0.006, 0.008, and 0.005, respectively). In the multivariate analysis, human papillomavirus (HPV) 16 positivity, premenopausal status, and absence of preoperative positive ECC result were identified as independent predictors of high concordance between CDB and LEEP results [odds ratio (OR): 1.72, 95% confidence interval (CI): 1.05–2.83, p = 0.031; OR: 2.47, 95% CI: 1.46–4.17, p = 0.001; and OR: 0.345, 95% CI: 0.193–0.616, p < 0.001, respectively]. Conclusion: The detection rate of ≥ CIN2 lesions in LEEP is predicted to be higher in patients with HPV type 16 positivity, premenopausal status, and the presence of a ≥ CIN2 lesion in the preoperative ECC.