Colposcopic evaluation of cervical lesions: a prospective study

Abstract

INTRODUCTIONCervical cancer continues to be a leading cause of mortality among women in our country, despite the existing prevention programmes. The role of organized screening programmes by conducting annual Pap smear test is undisputed and has been responsible for decreasing the incidence of cervical cancer in the western countries. But it seems that logistic requirements of these programmes cannot be met with in the developing countries.The present study was, therefore undertaken to evaluate the role of colposcopy as a screening and diagnostic tool for cervical cancer and other cervical lesions in high risk women. METHODSThe present study was carried out on patients attending the gynaecological OPD of SMI hospital, Dehradun with one or more of the following complaints:1. Women with post coital bleeding, intermenstrual bleeding, persistent vaginal discharge, vulval itching or burning.2. Women with cervical erosion or unhealthy cervix on per-speculum examination.3. Women with abnormal cytological (Pap test) findings. ABSTRACTBackground: The present study was undertaken to evaluate the role of colposcopy as a screening and diagnostic tool for cervical cancer and other cervical lesions in high risk women. Methods: All the women included in the study were subjected to colposcopic examination. Colposcopic findings were compared with cytology and histopathological examination. Accuracy of colposcopic examination was calculated by standard statistical methods. Sensitivity, specificity, Positive Predictive Valve (PPV) and Negative Predictive Valve (NPV) of colposcopic examination was calculated. Results: Three hundred patients underwent colposcopic examination. The overall sensitivity and specificity of colposcopy was 85.85% and 87.65% respectively. Positive predictive value was 75.83% and negative predictive value was 95.38%. The percentage of false negative as well as that of false positive was calculated to be 13.74%. The accuracy of colposcopy was found to be more for high grade lesions as composed to low grade lesions. Conclusions: Colposcopy gives immediate and accurate results and its value as diagnostic modality is undisputed. It should also be considered as a primary screening test for high risk women living in remote areas where women cannot visit the doctor repeatedly as the ideal screening triage cannot be implemented in such situations.

Comparison of Diagnostic Accuracy of Colposcopic Findings Using Modified Reid Colposcopic Index with Histopathology in Cervical Lesions

“…Over estmation of two cases on colposcopy includes CIN I (1case) and CIN II (1 case) which was diagnosed as chronic non specific cervicitis on histopathology while under estimation was seen in two cases of CIN I on colposcopy which was diagnosed as CIN II ( 1 case ) and CIN III (1 case) on histopathology and hence the accuracy of coloposcopic directed biopsies in our study was 92% which was comparable to that of the study conducted by Gupta V et al [13]. Under estimation may occur when high grade lesion may be over looked, which may appear as an inner border of sharp acetowhite demarcation within a less opaque acetowhite area [16].…”

Colposcopic evaluation of cervical erosion in symptomatic women

“…However, negative cytology does not always rule out CIN. 6,7 As also found in our study that pap smear diagnosed abnormality in 35 women (29.1%) women whereas colposcopy diagnosed the abnormalities in 50 (41.6%) women and therefore these 15 women (11.6%) would have missed if colposcopy was not done simultaneously. Referral for colposcopy, where the cervix may be closely inspected and biopsied, may still reveal CIN in some, even if a recent smear result is negative.…”

“…Positive iodine uptake giving mahogany-brown color negative uptake of insignificant lesion, i.e., yellow staining by a lesion scoring three points or less on the first three criteria areas beyond the margin of the transformation zone, conspicuous on colposcopy, evident as iodine-negative areas (such areas are frequently due to parakeratosis) 7 Partial iodine uptakevariegated, speckled appearance…”

Evaluation of cervical erosion in symptomatic women

“…Mahogany brown stain (normal) (88.23%) patients which is also comparable with this study. 12 • In a study by Kumari M et al on colposcopy in cervical erosion patients, 68% had normal findings and 30% had abnormal colposcopy. 13 • In the study by Bangal VB et al out of 100 patients of cervical erosion, 67% had normal colposcopic findings and 30% had abnormal findings.…”