Efficacy of Swede Score for See-and-Treat in VIA-Positive Women

Abstract

Objectives: Colposcopy standardization attempts have been made using scoring systems. One of them is the Swede score, which includes lesion size as a variable to be scored in addition to the four variables found in the modified Reids Colposcopic Index. The objective of the present study was to identify the Swede score associated with cervical intraepithelial neoplasia (CIN) 2+ lesions. Design: This was a prospective interventional study. Materials and Methods: Women in the age group of 25–50 years and coming to the general gynecology clinic had opportunistic cervical screening with visual inspection with acetic acid (VIA); screen positive underwent colposcopy and scoring of any acetowhite lesion using the Swede score. Those having a Swede score ≥5 were counseled for see-and-treat approach using large loop excision of the transformation zone (LLETZ). Histopathological examination of the LLETZ specimen was compared with the Swede score. Results: Colposcopy was carried out for 688 women who were VIA positive; of them, 101 had a Swede score of ≥5 and underwent LLETZ. On histopathological examination of the LLETZ sample, all had CIN. Of the 91 women (90.10%) who had Swede scores between 5 and 7, 36.26% had CIN 1 while 63.74% had CIN 2+ on HPE. At a Swede score of ≥8 (9.90%), 20% had CIN 1 and 80% had CIN 2+. A Swede score of ≥5 is associated with CIN 2+ in 65% and resulted in overtreatment in 34.6%. Conclusion: A Swede score of ≥5 was a good predictor of high-grade CIN lesion to counsel for the see-and-treat approach.