The importance of colposcopy in the prevention of cervical malignancies

Abstract

Pap smears are used for cytologic screening to reveal abnormalities in the cervical epithelium. Colposcopy enables a closer and more precise examination of the cervix, and is recommended for women for whom there is doubt regarding cervical dysplasia or cancer, in addition to those in whom an HPV infection is suspected and those with atypical squamous cells of undetermined significance [1]. Material taken through biopsy, conization, fractionated curettage, or hysterectomy should undergo histopathologic analysis. Cytodiagnosis has revolutionized the early diagnosis of precancerous conditions; when combined with colposcopy, its accuracy may reach 85%-90% [2].The aim of the present study was to determine the importance of cytology, colposcopy, and histopathology in the prevention of cervical malignancies.The study was carried out at In the absence of an ethics review council in Kosovo, institutional approval was obtained from the Director of the study center. All participants provided written informed consent.The study population comprised 750 women who had been admitted to the clinic for different reasons, and in whom cervical alterations were noted during speculum examination or who showed clinical symptomatology. All participants underwent Pap smears and colposcopy. In cases in which there was uncertainty regarding dysplasia, histopathologic examinations were performed.The majority of women with findings of Pap I-III were 31-40 years of age (Table 1). The fewest women with Pap I were younger than 20 years of age or 51-60 years of age (both 8.3%) ( Table 1). The most common findings among the 187 patients with atypical colposcopic changes were mosaic (36.4%) and leukoplakia (26.7%) (data not shown).None of the patients younger than 20 years of age had atypical epithelial changes.In addition to the material obtained during colposcopy, biopsies were taken from 117 women. Histopathologic analysis of the biopsied tissue revealed different levels of dysplasia in 16.2% of cases, carcinoma in situ in 5.1%, and invasive carcinoma in 2.6%. The highest percentage of atypical epithelium was verified in the context of atypical colposcopy findings: leukoplakia; mosaic; punctuation; and vascular atypia. Of the patients with leukoplakia who underwent biopsy, dysplasia was verified by histopathology in 25.0%; of the women with mosaic dysplasia, the findings were verified by histopathology in 21.4%; of the women with punctuation dysplasia, the results were verified histopathologically in 16.7%; of the patients with vascular atypia, dysplasia was verified histopathologically in 12.5% (Table 2). Atypical epithelium was verified histopathologically only very rarely, when there was either an atypical transformation zone or cervical erosion. There were 6 cases of carcinoma in situ, whereas Table 1 Cytologic results of cervical examination according to age group. aAge, y Pap Total (n = 750) I (n=60) II (n=525) III (n=123) IV (n=38) V (n=4) b 20 5 (8.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (0.7)

Precancerous lesions of the cervix — aetiology, classification, diagnosis, prevention

“…Colposcopy plays a key role in the diagnosis and treatment of cervical precancers [8][9][10][11][12][13].…”

“…-Colposcopy allows for the identification, location and outlining of CIN lesions on the cervix, vagina and vulva [8]. -Colposcopy is mandatory for diagnosing and treatment of CIN.…”

“…A satisfactory (adequate) colposcopic examination is one in which the squamous-cylindrical epithelium border and the borderlines of the atypical epithelium are clearly visible. Unsatisfactory (inadequate) colposcopy is the one with an unclear squamous-cylindrical epithelium border and/or an unclear distal border of an atypical lesion [8][9][10][11][12][13] (Fig. 3, 4).…”