Performance of the R-way Colposcopic Evaluation System in Cervical Cancer Screening

  • Zhao, Jian (Department of Gynaecology and Obstetrics, Peking University First Hospital, Peking University Health Science Center, Peking University) ;
  • Zhang, Xi (Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College) ;
  • Chen, Rui (Beijing Tsinghua Changguang Hospital, Capital Medical University) ;
  • Zhao, Yu-Qian (Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College) ;
  • Wang, Ting-Ting (Chinese Center For Disease Control And Prevention) ;
  • He, Shan (Beijing Luhe Hospital, Capital Medical University) ;
  • Qiao, You-Lin (Department of Cancer Epidemiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College)
  • Published : 2015.06.03


Objective: To investigate the diagnostic value of the R-way colposcopic evaluation system (R-way system) in cervical cancer screening. Materials and Methods: Between August 2013 and August 2014, a total of 1,059 cases referred to colposcopy in Peking University First Hospital were studied using both the R-way system and conventional colposcopy. Our study evaluated and compared the diagnostic ability of the two methods in detecting high-grade lesions and cervical cancer (hereinafter called CIN2+). Evaluation indicators including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), Youden index and the area under the curve (AUC) of the receiver operating characteristic (ROC) were calculated. Results: The R-way system had a slightly lower specificity (94.5%) than conventional colposcopy (96.0%) for CIN2+ detection (P=0.181). However, the sensitivity (77.8%) was significantly higher than with the conventional colposcopic method (46.6%) (${\chi}^2=64.351$, P<0.001). In addition, the AUC of the ROC for CIN2+ detection using the R-way system (0.839) was larger than that with conventional colposcopy (0.731) (Z=4.348, P<0.001). If preliminary result had been drawn from cervical exfoliated cytology before colposcopy referral, combination of the R-way system with cytology could increase the sensitivity to 93.9% for CIN2+ detection (excluding ASCUS\LSIL), confirmed by multipoint biopsy or ECC. Conclusions: The diagnostic value of the R-way evaluation system is higher than that of conventional colposcopic evaluation in cervical cancer screening. Moreover, taking the ease of use and standardized quality control management into account, the R-way system is highly preferable.


R-way colposcopic evaluation system;conventional colposcopic examination;cervical cancer screening


  1. Bornstein J, Bentley J, Bosze P, et al (2012). 2011 Colposcopic terminology of the international federation for cervical pathology and colposcopy. Obstet Gynecol, 120, 166-72.
  2. Cristiani P, Costa S, Schincaglia P, et al (2014). An online quality assurance program for colposcopy in a population-based cervical screening setting in Italy: results on colposcopic impression. J Low Genit Tract Dis, 18, 309-13.
  3. Darragh TM, Colgan TJ, Thomas Cox J, et al (2013). The lower anogenital squamous terminology standardization project for HPV-associated lesions: background and consensus recommendations from the college of American pathologists and the American society for colposcopy and cervical pathology. Int J Gynecol Pathol, 32, 76-115.
  4. Di Stefano L, Patacchiola F, Necozione S, et al (2014). The correspondence between abnormal transformation zone grade 1 and grade 2 colposcopic parameters and histology. clinical implications. Eur J Gynaecol Oncol, 35, 16-9.
  5. Diedrich JT, Felix JC, Lonky NM (2014). Contribution of exocervical biopsy,endocervical curettage, and colposcopic grading in diagnosing high-grade cervical intraepithelial neoplasia. J Low Genit Tract Dis, 18, 1-7.
  6. Ghosh I, Mittal S, Banerjee D, et al (2014). Study of accuracy of colposcopy in VIA and HPV detection-based cervical cancer screening program. J Obstet Gynaecol, 54, 570-5.
  7. Massad LS, Einstein MH, Huh WK, et al (2013). 2012 ASCCP consensus guidelines conference. 2012 updated consensus guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. J Low Genit Tract Dis, 17, 1-27.
  8. Petry KU, Luyten A, Scherbring S, et al (2013). Accuracy of colposcopy management to detect CIN3 and invasive cancer in women with abnormal screening tests: results from a primary HPV screening project from 2006 to 2011 in Wolfsburg, Germany. Gynecol Oncol, 128, 282-7.
  9. Qiao YL, Sellors JW, Eder PS, et al (2008). A new HPV-DNA test for cervical-cancer screening in developing regions: a cross-sectional study of clinical accuracy in rural China. Lancet Oncol, 9, 929-36
  10. Quaas J, Reich O, Kuppers V (2014). Explanation and use of the colposcopy terminology of the IFCPC (international federation for cervical pathology and colposcopy) Rio 2011,Geburtshilfe und Frauenheilkunde, 74, 1090-2.
  11. Sigel R, Ma JM, Zou ZH, et al (2014). Cancer Statistics, 2014. Cancer J Clin, 64, 9-29.
  12. Tatiyachonwiphut M, Jaishuen A, Sangkarat S, et al (2014). Agreement between colposcopic diagnosis and cervical pathology: Siriraj hospital experience. Asian Pac J Cancer Prev, 15, 423-6.
  13. Thulaseedharan JV, Malila N, Esmy PO, et al (2015).Risk of invasive cancer among women visually screened and colposcopy triaged by trained nurses in rural south India. Int J Gynaecol Obstet [Epub ahead of print].
  14. Torre LA, Bray F, Siegel RL, et al (2014). Global cancer statistics, 2012. CA Cancer J Clin [Epub ahead of print].