Comparison of colposcopic findings between cytologically screened positive and negative women with postcoital bleeding

Abstract

Objectives The aim of the study was to compare colposcopic findings between cytologically screened positive and negative women presenting with postcoital bleeding (PCB) to establish the prevalence of underlying cervical pathology. Study design This was a prospective study. Patients and methods Eighty-three consecutive women referred to the colposcopy clinic primarily for PCB were enrolled between January 2011 and April 2012. They underwent a speculum examination, cervical cytological examination, and colposcopy with diagnostic biopsies. Results Of the 83 women, 32 had positive results on cytological examination. These women more likely to have abnormalities on colposcopy (P=0.015) and a high incidence of preinvasive or invasive lesions (P=0.004) compared with women with negative cytological results. The overall incidence of cervical intraepithelial neoplasia (CIN) grade 1 was 13.2%, that of CIN 2 and 3 was 7.2%, and that of squamous cell carcinoma was 2.4%. Of note, of 51 women with a negative cytological result, 7.8% had CIN 1 and 3.9% had CIN 2 or 3; 47.4% of women with high-risk lesions were oral contraceptive pill users. The sensitivity of cervical smear in the diagnosis of high-risk abnormality was 68.4%, specificity was 70.3%, and positive predictive value and negative predictive value were 40.6 and 88.2%, respectively. The same parameters for colposcopy with multiple biopsies were 84.2, 87.5, 66.6, and 94.9%, respectively. Conclusion PCB should be considered an indication for cervical cancer or CIN even with a negative smear, although the majority of women had benign lesions. The diagnostic performance of colposcopy in the detection of high-risk lesions in such patients can be improved by performing multiple biopsies even in those with apparently normal view. This initial finding helps to avoid overtreatment and repeated excisional biopsies.