Routine Colposcopy and Cytology During Pregnancy for Detection of Cervical Premalignant and Malignant Lesions

Abstract

Routine cervical cytology and colposcopy were done in 500 successive pregnant females. In 29 (5.9%), colposcopically abnormal areas were found on the cervix, 4 outside and 25 within the transformation zone (TZ). Colposcopically directed biopsies from these areas revealed acanthotic epithelium in the 4 cases outside the TZ and in 13 cases within the TZ (52% of cases), chronic cervicitis in one (4%), and cervical intraepithelial neoplasia (CIN) II or III in 13 (44%); in other words, the false positive colposcopy rate was 56%. However, all cases with acanthotic epithelium showed minor colposcopic changes, namely, leukoplaskia, finely punctated or mosaic-like and faint, unraised acetowhite areas. The number of colposcopically directed biopsies could have been reduced by more than 50% if biopsy was taken from areas that showed such major colposcopic findings as coarse punctation and mosaic patterns, atypical vessels, or intense white and raised acetowhite areas. Routine Papanicoleau smear revealed dyskaryotic cells in 10 women (20% of cases), which were diagnosed as mild in 3, moderate in 5, and severe in 2. Of these cases, 8 showed CIN; in other words, the false positive cytology rate was 20%. In the 11 women with histologically proven CIN, Pap smear revealed dyskaryotic cells in 8 (72.2%); in other words, the false negative cytology rate was 27.3%.