Observed Colposcopy Practice in US Community-Based Clinics: The Retrospective Control Arm of the IMPROVE-COLPO Study

OBJECTIVE: The aim of the study was to characterize colposcopy practice and management of women with cervical abnormalities in US community-based clinics. MATERIALS AND METHODS: IMPROVE-COLPO was a 2-arm study of colposcopy patients with an abnormal screening result. The prospective arm recruited women to undergo examination with a commercial digital colposcope. The retrospective-control arm collected data (chart review) from previous colposcopies performed using standard equipment and methods. From the retrospective arm, we analyzed referral trends, colposcopy and biopsy practice, and management patterns. RESULTS: We collected data of 3,602 eligible women (median age = 34 years) that had been examined from 2012 to 2017 by 154 colposcopists at 44 clinics across 12 states. Most patients were premenopausal (87.9%), privately insured (88.2%), and had a low-grade (low-grade squamous intraepithelial lesion/atypical squamous cells of undetermined significance/human papillomavirus positive) indication (87.2%). Most colposcopists performed less than 3 colposcopies monthly and their biopsy rate was1.47 biopsies/patient for high-grade referrals and 0.97 for low-grade referrals (p < .001). Random biopsy was rare (0.4% of biopsies). Most women(74.9%) underwent endocervical sampling, including 62.5% of women aged 21 to 24 years. Colposcopic impression was frequently not reported(58.8%), and its sensitivity to predict histology-confirmed cervical intraepithelial neoplasia (CIN) 2+ as “high-grade” was 56.5% for high-grade referrals and 23.2% for low-grade referrals. Excisions often (44.5%) returned <CIN 2, including patients aged 21–40 years (37.4%). CONCLUSIONS: In this analysis, most colposcopists performed few colposcopies and took less than 2 biopsies per patient. Colposcopic impression had a poor sensitivity to predict histology-confirmed CIN 2+. Although recent research indicates that taking multiple biopsies improves sensitivity and detection of CIN 2+, this is not being practiced in the US.