Comparison Between Modified Reid Index and Swede Score in Visual Inspection by Acetic Acid (VIA)-Positive Women Suspected of Cervical Cancer

Abstract

Modified Reid index helps to objectively differentiate between low-grade and high-grade lesions during colposcopy; however, its differentiating ability is often debated. Swede score is a relatively newer score for the purpose. In the present study, we compared the efficacy of modified Reid index and Swede score in evaluation of visual inspection by acetic acid (VIA) positive women. A total of 57 VIA-positive women underwent colposcopic evaluation followed by histopathological confirmation. Women with obvious growth, previous procedures on the cervix, pregnancy, nulliparity and history of pelvic irradiation were excluded. Colposcopic findings were scored using modified Reid index and Swede score, respectively. The diagnostic efficacy of modified Reid index and Swede score was done using sensitivity, specificity, positive and negative predictive values. Mean age of women was 37.53 ± 8.98 years. On colposcopy, according to modified Reid index, a total of 26 (45.6%) were likely to be CIN I, 29 (50.9%) were CIN I/II, and 2 (3.5%) were CIN II/III. According to Swede score, 38 (66.7%) were low grade (normal/CIN I), 11 (19.3%) were high grade (non-invasive CIN II or above) and 8 (14%) were high grade (suspected invasive/CIN II or above). On histopathology, 34 (59.6%) were diagnosed as cervicitis, 10 (17.5%) were low grade (CIN I/mild dysplasia), 5 (8.8%) high grade (CIN II/moderate dysplasia), 2 high grade (CIN III/severe dysplasia) and 6 (10.5%) carcinoma cervix, respectively. For high-grade lesions/carcinoma at a cut-off value 8 or above modified Reid index had sensitivity, specificity, PPV and NPV of 33.3%, 100%, 100% and 92.7%, respectively, as compared to 61.5%, 100%, 100% and 88.6%, respectively, for Swede score at a cut-off > 7. For high-grade lesions, Swede score was found to be more sensitive as compared to modified Reid index in VIA-positive women.