Abstract
Background: Cervical cancer is the most frequent cancer in women worldwide. It is a preventable and curable disease with proper screening. After primary screening Colposcopy is a valuable tool in the detection and treatment of precancerous cervical lesions. Histopathology is the gold standard method of diagnosis of Precancerous lesions.
 Objective: The objective of this study was to evaluate the performance of colposcopy in the diagnosis and to make correlation between colposcopic & histopathological findings in precancerous cervical neoplasia (CIN).
 Materials and Method: It was a cross sectional study, conducted at the Colposcopy Clinic, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. Study was done for a period of one year from January, 2016 to December, 2016. Sixty two married women having following complaints: positive visual inspection of cervix (VIA + ve) with 3-5% Acetic acid, postcoital bleeding, postmenopausal bleeding, and intermenstrual bleeding were recruited for the study. Written informed consent was obtained from the participants. The questionnaire was pretested, corrected and finalized. The data collection was done using the interviewer administered questionnaire. Colposcopic examination of cervix was done in 62 participants. Colposcopy guided punch biopsy/Loop electrosurgical excision procedure (LEEP) from acetowhite area was taken in cases of VIA +ve women and random four quadrants (1, 5, 7 & 11 O’ clock position) cervical biopsy in cases of VIA – ve women having other indications. Histopathological examinations of specimens were done in the Department of Pathology, BSMMU. Descriptive analysis, chi-square test (X2) and Fisher’s exact test were performed. P value<0.05 was taken as statistically significant.
 Result: The mean age of the study population was 36.8±11.9 years ranging from 20 to72 years. Out of 62 participants, 40.3% (n=25) had VIA positive, 41.9% (n=26) had postcoital bleeding among which 24 was VIA positive and 2 was VIA negative, 8.1% (n=5) had intermenstrual bleeding with positive VIA and 9.7% (n=6) post-menopausal bleeding among which 4 was VIA positive and 2 was VIA negative. Among total 62 participants
 Sensitivity of colposcopy to diagnose histopathologically confirmed CIN I was 82.6%, CIN II was 25% and CIN III was also 25%. The specificity to diagnose CIN I was 42.4%, CIN II was 91.4% and CIN III was 93.1%. PPV of colposcopy to diagnose histologically confirmed CIN I was 55.8%, CIN II was 16.7% and CIN III was 20%. The NPV to diagnose CIN I was 73.7%, CIN II was 94.6% and CIN III was 94.7%. The colposcopic accuracy to diagnose CIN I was 61.3%, CIN II was 87.1% and CIN III was 90.3%. There was statistically significant (P value <0.05) correlation for colposcopic diagnosis of histopathologically confirmed CIN I,CIN II and III.
 Conclusion: The accuracy of colposcopy to diagnose histopathologically confirmed precancerous cervical lesions was quite high. Patients presenting with postcoital bleeding and postmenopausal bleeding should have colposcopy and biopsies even if the screening test result normal. Moreover colposcopy has high sensitivity, so we can easily adopt the see and treat method to reduce the dropout.
 Bangladesh Med Res Counc Bull 2020; 46(1): 48-54
Highlights
Cervical cancer is most frequent cancer in women worldwide
Sixty two married women having following complaints: positive visual inspection of cervix (VIA + ve) with 3-5% acetic acid, postcoital bleeding, postmenopausal bleeding, and intermenstrual bleeding were recruited for the study
Patients presenting with postcoital bleeding and postmenopausal bleeding should have colposcopy and biopsies even if the screening test result normal
Summary
Cervical cancer is most frequent cancer in women worldwide. In 2012, there was an estimated 5, 30,000 new cases. More than 85% of these deaths occur in less developed regions.[1] In 2012, there was an estimated 4, 45,000 new cases. Bangladesh with an estimated 11,956 new cases and 6,582 deaths in 2012.2 In Bangladesh, cervical cancer is the most common reproductive cancer in women, and most women present when it is too late.[3] Cervical cancer is responsible for the highest rate of mortality among Bangladeshi women.[4] More than 80% of patients diagnosed with this eminently preventable cancer presents at clinically advanced and inoperable stages.[5] As per Precancerous cervical lesions the International Agency for Research on Cancer (IARC’s) projections for coming decades, deaths from cervical cancer will continue to rise.[6]. Cervical cancer is the most frequent cancer in women worldwide. It is a preventable and curable disease with proper screening. After primary screening Colposcopy is a valuable tool in the detection and treatment of precancerous cervical lesions. Histopathology is the gold standard method of diagnosis of precancerous lesions
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