Papanicolaou, colposcopia y biopsia en detección temprana en cáncer de cuello uterino. Revisión Sistemática

Abstract

Background: According to Ecuador’s National Institute of Statistics and Censuses (INEC, by its Spanish acronym) in 2022, cervical cancer ranks among the top 10 causes of death in the country. Reports up to 2020 place cervical cancer (CaCu) as the fourth most common neoplasm worldwide. Its etiology is multifactorial, with HPV infection being considered the main risk factor. According to the WHO, the Papanicolaou test remains the primary screening method for the early detection of precancerous cervical lesions. Objective: This systematic review aims to determine the diagnostic accuracy of the Papanicolaou test and colposcopy in the early identification of cervical cancer, confirmed by biopsy. Method: This study uses a quantitative, prospective, and descriptive approach, gathering data from 2019 to 2023 from sources such as PubMed, Elsevier, and SciELO. Results: Sensitivity and specificity results for the Papanicolaou test and colposcopy showed broad variability. A reference study from Kazakhstan reported that colposcopy had a sensitivity of 82% and a specificity of 73% for low-grade squamous intraepithelial lesions (LSIL), with a specificity of 88% for cervical intraepithelial neoplasia grade 2 or higher (CIN2+). Cytology (Pap smear) showed a sensitivity of 90% and specificity of 75% for CIN2+. Conclusions: Although colposcopy is useful, cytology demonstrates higher sensitivity in detecting high-grade dysplasia. Therefore, it is recommended to compare cytology and colposcopy results with histopathology to ensure an accurate diagnosis. Keywords: cervical cancer, Papanicolaou test, colposcopy, biopsy, specificity