‚See and treat’ strategy for HSIL: correlation between colposcopy and histopathology

Abstract

We sought to determine the correlation between the colposcopic impression (by means of RCI- Reid Colposcopic Index) and histopathology in patients who have undergone LEEP (‚see and treat’ strategy) for cytological high-grade dysplasia. This was a prospective study carried out in ”Prof. Dr. Panait Sârbu” Hospital in Bucharest over a 10-month period. A total of 112 women diagnosed with HSIL on PAP exam underwent LEEP without prior colposcopically directed biopsy. We assessed the relationship between the histologic diagnosis and the colposcopic aspect (RCI), age, parity, AFSI (age at first sexual intercourse) and AFP (age at first pregnancy) AFSI latency. Among 112 women treated, 102 (91.07%) had histologically proven high-grade dysplasia (≥CIN2) and 2 (1.78%) of them had microinvasive squamous cell carcinoma. 80 patients (78.43%) of the 102 had high-grade colposcopic impression; of the 30 patients with normal/ low-grade colposcopy, 22 (73.3%) had high-grade lesions on final histologic exam. The correlation between RCI and histology was fair (κ=0,205; 95% CI, 0.08-0.32, p=0.001). There was no statistically significant connection between age, AFSI, parity, AFP-AFSI latency and RCI and histologic result. The correlation between RCI and histologic findings is fair , especially for CIN3 lesions; the high percentage (91.07%) of histologically proven high-grade dysplasia on LEEP specimens make ‚see and treat’ strategy an attractive option in the management of HSIL results on PAP smears.