Nomogram for Predicting Pathological Discordance between Colposcopy- directed Biopsies and Cold Knife Conization Findings

Objective We aimed to develop a nomogram for predicting the probability of discordance between colposcopy-directed biopsy and cold knife conization pathological findings. Methods This was a quantitative research involving a case-control study. We retrospectively reviewed the records of patients diagnosed with high-grade squamous intraepithelial lesions through colposcopy-directed biopsy, who underwent cold knife conization at the Second Hospital of Shanxi Medical University between September 2018 and September 2021. The nomogram was developed using multivariate logistic regression analysis to predict the risk of pathological discrepancies between colposcopy-directed biopsy and cold knife conization findings. Results The colposcopy-directed biopsy accuracy rate for identifying high-grade squamous intraepithelial lesions was 72.8%. Multivariate analysis showed that cervical intraepithelial neoplasia Grade 3 (odds ratio [OR] = 9.455, P-value < 0.001), positive endocervical curettage (OR = 5.407, P-value < 0.001), findings of high-grade squamous intraepithelial lesions/atypical squamous cells cannot exclude high-grade squamous intraepithelial lesions/atypical glandular cells (OR = 1.791, P-value = 0.044), and peripheral blood lymphocyte count (OR = 0.523, P-value = 0.018) were associated with colposcopy-directed biopsy underestimation. Cervical intraepithelial neoplasia 2 (OR = 2.369, P-value < 0.001), negative endocervical curettage (OR = 3.271, P-value < 0.001), negative for intraepithelial lesions or malignancy/atypical squamous cells of undetermined significance/low-grade squamous intraepithelial lesion (OR = 2.362, P-value = 0.004), and peripheral blood monocyte count (OR = 7.989, P-value = 0.016) were associated with colposcopy-directed biopsy overestimation per the multivariate analysis. The above factors were used to construct nomograms for predicting colposcopy-directed biopsy underestimation or overestimation, which had area under the curve values of 0.815 (95% confidence interval [CI]: 0.767−0.863) and 0.742 (95% CI: 0.690−0.793) for underestimation and overestimation, respectively. Conclusions Our results suggest a significant discordance between colposcopy-directed biopsy and cold knife conization pathological results, which could prompt nonessential conization or delayed treatment, particularly for fertile women. Our nomogram models may help estimate the probability of colposcopy-directed biopsy underestimation and overestimation, enhancing individualized treatment plans.