2. COLPOSCOPY RANDOM CERVICAL BIOPSIES ENDOCERVICAL CURETTAGE Robert.G.Pretorius@kp.org S.C.P.M.G.-Fontana

4. I II IV III

5. Pretorius RG et. al. JLGTD 2011;15:180-8 PROPORTION OF CIN 3 OR CANCER (CIN 3+) DIAGNOSED BY COLPOSCOPICALLY DIRECTED BIOPSY OF A VISIBLE LESION, ‘RANDOM’ BIOPSY FROM A CERVICAL QUADRANT WITHOUT A LESION, OR SOLELY BY ECC OF CIN 3+ Colposcopically Directed ‘Random’ Solely ECC3+ 63.5% (141/222) 25.7% (57/222) 10.8% (24/222)

6. 1 p for trend <.001 from Pretorius RG et. al. JLGTD 2011;15:180-8 SENSITIVITY FOR CIN 3 OR CANCER (CIN 3+) OF BIOPSY OF CERVICAL QUADRANTS WITH COLPOSCOPIC IMPRESSION OF HPV, CIN, OR CANCER AS A FUNCTION OF THE NUMBER OF CERVICAL QUADRANTS WITH CIN 3+ (0 quadrants is diagnosis solely by positive ECC) 0 Quadrant with CIN 3+ 1 Quadrant with CIN 3+ 2 Quadrant with CIN 3+ 3 Quadrant with CIN 3+ 4 Quadrant with CIN 3+ Sensitivity Colposcopy 0% (0/24) 58.5% 1 (62/106) 81.1% 1 (43/53) 84.2% 1 (16/19) 100% 1 (20/20)

7. Yang B et. al. Gynecol Oncol 2008;110:32-6 AVERAGE EPITHELIAL THICKNESS (MICRONS) BY COLPOSCOPIC IMPRESSION AND HISTOLOGY (SELECTED REVIEW OF SPOCCS I SLIDES) HISTOLOGYCOLPO IMP NORMAL COLPO IMP LOW COLPO IMP HIGH COLPO IMP CANCER NORMAL 378 370 482 CIN 1 355 346 418 310 CIN 2 185 258 334 346 CIN 3 181 230 372 426

8. Pretorius RG et. al. JLGTD 2011;15:180-8 YIELD OF CIN 3 OR CANCER PER COLPOSCOPY

9. COMPARISON OF CHINA COLPOSCOPY CLINIC (in which eligible women were 35 to 50 years of age, had colposcopy for cytology of Cancer, HSIL, AGUS, LSIL, or ASC-US with positive HR-HPV and were diagnosed with CIN 3+ only by cervical biopsy and/or ECC showing CIN 3+) WITH A SIMILAR MATCHED SERIES FROM S.C.P.M.G.- FONTANA 2007-2009 China series S.C.P.M.G.-Fontana Prevalence CIN 3+ 2.3% (222/10,425) 0.2% (71/42,803) Prevalence Cancer 0.2% (21/10,425) 0.03% (13/42,803) % cervical CIN 3+ with negative colposcopy 22.7% 1 (45/198) 23.1% 1 (15/65) % CIN 3+ diagnosed by ECC of CIN 3+ 10.8% 2 (24/222) 8.5% 2 (6/71) Median age (years) 40 43 1 22.7% vs. 23.1%, p=.95, 2 10.8% vs. 8.5%, p=.57, Pretorius RG et. al. JLGTD2012;16:333-8

10. Pretorius RG et. al. JLGTD 2012;16:333-8 PROPORTION OF CIN 3 OR CANCER (CIN 3+) IN S.C.P.M.G.-FONTANA COLPOSCOPY CLINIC 2007-2009 DIAGNOSED SOLELY BY ECC of CIN 2+ AGE (Years) CIN 3+ SOLELY BY ECC 16-24 0.0% (0/32) 25-34 6.6% (7/105) 35-44 7.5% (7/93) 45-54 22.6% (7/31) ≥55 27.7% (5/18) Total 9.3% (26/279)

11. ‘RANDOM’ BIOPSIES IN CERVICAL QUADRANTS WITHOUT VISIBLE LESIONS AND ECC SHOULD BE DONE AT COLPOSCOPY FOR EVALUATION OF ABNORMAL CERVICAL CANCER SCREENING TESTS THE ECC MAY BE OMITTED ON WOMEN UNDER AGE 25 YEARS Pretorius RG et. al. JLGTD 2012;16:333-8

13. THANK YOU FOR YOUR ATTENTION Robert.G.Pretorius@kp.org