Colposcopic Index Research Articles

Colposcopic and Histopathologic Comparative Interpretations Among Patients Undergoing Evaluation for Cervical Dysplasia in Western Kenya

Objective: To determine the correlation between colposcopic and final histopathologic results amongst patients undergoing a colposcopic evaluation in cervical dysplasia clinics in Western Kenya. Methods: This was a cross-sectional study, conducted among 164 females undergoing colposcopic evaluation across several cervical dysplasia clinics in Western Kenya. Colposcopy and histopathology were performed. Colposcopy findings were graded using modified Reid’s Colposcopic Index (RCI). Bayes’ theorem model was used to determine the sensitivity, specificity, positive predictive value, and negative predictive value. An overall ĸ value was calculated as an estimate of the strength of correlation between colposcopy and histopathology. Results: Mean age of the study participants was 40.6 years. Modified RCI classified 20.7%, 40.2%, and 39.1% between a score of 0–2, 3–5, and 6–8, respectively. Colposcopy classified 0.6%, 38.4%, and 60.1% as normal, cervical intraepithelial neoplasia (CIN) 1 (low risk), and CIN 2–3 (medium–high risk), respectively. Histopathology classified 16.5%, 26.2%, 53.3%, and 3.0% as having normal, CIN 1, CIN 2–3, or carcinoma in situ, respectively. Sensitivity, specificity, positive predictive value, and negative predictive value were 85.3%, 69.7%, 80.3%, and 69.7%, respectively. The estimated strength of correlation between colposcopy and biopsy was relatively strong (ĸ=0.55). Conclusion: There is an association between the discriminatory powers of colposcopy and histology, but colposcopy had a lower specificity when compared to histopathology.

Modified swede colposcopic index versus modified reid index in colposcopic screening for premalignant & malignant lesions of the cervix: a cross-sectional analysis

BackgroundCervical cancer cases in India account for one-fourth of the worldwide burden. Colposcopy is used to evaluate the cervix of women with abnormal screening test results. For standardized reporting, various scores were introduced of those, Reid Colposcopic Index (RCI) and Swede score are the most commonly used. Aims and ObjectivesThis study is undertaken to determine the diagnostic efficacy and clinical relevance of the newly introduced MSCI and compare MSCI and Modified Reid Index. Results225 women out of 237 were analyzed. MSCI score 9 perform best for colposcopic diagnosis of CIN 2 or higher lesions. The sensitivity, specificity, PPV, and NPV for threshold score 9 for CIN 2 or higher lesions were 94.92 %, 67.88 %, 51.38 %, and 97.39 % respectively. Modified Reid Index threshold 3 performed best for the detection of CIN 2 or higher lesions with a sensitivity, specificity, PPV, and NPV of 84.75 %, 44.85 %, 35.46 %, and 89.16 % respectively. On comparing the area under the curve (AUC) for MSCI and MRI, we found that the difference between the AUC of MSCI (0.854) and Modified Reid Index (0.657) was significant (P < 0.05). ConclusionMSCI performs better than the modified reid index for the diagnosis of both HGL and LGL or higher. Also, the omission of impractical measurements and inclusion of easier and more practical parameters than the Swede score or Modified Reid Index makes MSCI a simple and effective screening tool

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

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.

Effects of photodynamic therapy in the treatment of high-grade vaginal intraepithelial lesions following hysterectomy and HPV infection

BackgroundNon-invasive treatment therapy, such as 5-Aminolevulinic acid photodynamic therapy (ALA-PDT), has gained attention for its effect on select cervical and vaginal lesions. To investigate the effect of ALA-PDT on high-grade vaginal intraepithelial lesions (HG VAIN) after hysterectomy and high-risk human papillomavirus (HR-HPV) infection, in this study, we evaluated the clinical efficacy and safety of ALA-PDT in 23 patients with HG VAIN following hysterectomy and HPV. Methods23 patients with HG VAIN after hysterectomy were selected for photodynamic therapy, and the therapeutic effect, adverse reactions, recurrence rate and HPV clearance rate were analyzed respectively. The patients were followed up at 3, 6, 9, and 12 months after ALA-PDT. HPV, thinprep cytologic test (TCT) and reid colposcopic index (RCI) score should be performed 3 months after treatment. When the RCI score is higher than or equal to 3, a colposcopy biopsy should be conducted, the additional ALA-PDT should be continued if residual lesions were detected. When the RCI score is lower than or equal to 2, HPV and TCT should be reviewed every 3 months. ResultsAfter 3 months of photodynamic therapy, 21 patients were cured, with the cure rate of 91.3% (21/23). Two patients (8.7%) had residual lesions, which had degraded compared with the previous. After treatment, the overall HR-HPV clearance rate was 56.5% at 3 months, 65.2% at 6 months, 69.5% at 9 months, and 74% at 12 months. No obvious adverse reactions were found during and after treatment. Moreover, no recurrence occurred during the whole follow-up period. ConclusionsCompared with other therapies, ALA-PDT is a novel therapy with non-invasive procedure in HG VAIN after hysterectomy. ALA-PDT can be used for the treatment of HG VAIN after hysterectomy, moreover, it can not only effectively clear HR-HPV, but also can prevent the recurrence and progression of vaginal lesions caused by persistent HR-HPV infection.

Comparative Analysis between Reid’s Colposcopic Index and Swede’s Score for Detection of Premalignant Lesions of Cervix: A Prospective Study

Introduction: Colposcopy is an effective tool to detect premalignant lesions of the cervix. It is an observer-dependent technique; hence, various colposcopic-based scoring systems have been employed to minimise interobserver variations. Aim: To compare Reid’s Colposcopic Index (RCI) and Swede’s score for the detection of premalignant lesions of the cervix and compare it with colposcopic directed biopsy and histopathology. Materials and Methods: In this prospective observational study conducted at a tertiary care hospital in Delhi, India, between August 2019 to April 2020, 100 women of the reproductive age group were recruited. Pap (Papanicolaou) smear and colposcopy were done for all the patients. Scoring of colposcopic lesions was done according to Reid’s and Swede’s scoring system. In women with RCI or Swedes score ≥3, biopsy of the cervix for histopathology was carried out. Data was recorded and statistically analysed using Statistical Package for the Social Sciences (SPSS) software. Pearson and spearmen correlation coefficient was used for correlation of RCI and Swede’s score. Results: Mean age of women was 43.89±8.2 years. A positive correlation was found between RCI and Swedes score as the correlation coefficient was 0.995 and p-value&lt;0.001. Sensitivity was better with Swede’s scoring system as compared to RCI for predicting Cervical Intraepithelial Neoplasia (CIN)-I lesions. However, for predicting CIN-II and CIN-III lesions sensitivity with both the scoring system was comparable. The sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) of RCI at a cut-off score of 5 was 54.54%, 87.17%, 54.54%, and 87.1% for CIN-I, for CIN-II was 100%, 86.67%, 45.45%, and 100%. CIN-III was 100%, 82.1%, 22.7%, and 100%. Similarly, the sensitivity, specificity, PPV, and NPV of Swedes score at a cut-off score of 5 was 59%, 84.6%, 52%, and 88% for CIN-I, for CIN-II was 100%, 83.33%, 40%, and 100%. And that for CIN-III was 100%, 78.94%, 20% and 100%. Conclusion: Both scoring systems performed well in predicting CIN lesions.

Colposcopic Findings in Patients of Cervical Erosion at Tertiary Center

Background: India has a population of approximately 450 million women 18 years of age and older who are at a risk of developing cervical cancer. Recent studies state that nearly every year 122844 women are diagnosed with cervical cancer and approximately 67477 die from cervical cancer. Cervical cancer ranks as the 2nd most frequent cancer among women in India. Cervical erosion is one of the commonest clinical finding in women attending Gynecology outpatient department for various reasons. Cervical erosion which is an abnormality of the cervical epithelium covering ectocervix, has a varied significance. It could be a premalignant or a malignant lesion. Persistent inflammation leads to increased cellular turnover. Cervical cancer can be prevented by detecting precancerous lesions by screening and treating them in time. Inspite of the overall high incidence and mortality rates, cervical cancer is considered as the most preventable and treatable form of major cancer through early diagnosis and appropriate treatment of pre invasive and invasive disease. Early detection of cervical epithelial abnormality is important as it helps to prevent progression to CIN and invasive cancer thereafter. Aim: To study the colposcopic findings in patients of cervical erosion. Material and methods: A prospective observational study was carried out in the time interval from October 2019 to September 2021 at Rural Medical College, Loni. Women diagnosed to have cervical erosion on per speculum examination were enrolled for the study. A total 140 females were studied. Women attending gynecological Outpatient department for various complaints and diagnosed to have cervical erosion on per speculum examination were enrolled in the study. Colposcopy was done using 3% acetic acid and 50% Lugol’s iodine. Colposcopy was done and it was interpreted using the Reid’s Colposcopic Index which is an objective method of colposcopically grading the severity of premalignant cervical lesions. ................

Prospective Evaluation of Correlation between Modified Reid’s Colposcopic Index (RCI) and Histopathology Result from Colposcopic Directed Biopsy

Objective: To evaluate correlation between Modified Reid Colposcopic Index and histopathology from colposcopic directed biopsy. Materials and Methods: At least atypical squamous cell of undetermined significance (ASC-US) according to the Bethesda classification 2001 was diagnosed in 60 eligible women. At the time of colposcopic examination, the four colposcopic criteria used are: 1) margin of cervical lesion, 2) color of acetowhite, 3) appearance of vessels on cervical lesion, and 4) location of the lesion. Each criterion was assigned in score between 0 to 2 and the summation of all four criteria made a total score ranging from 0 to 8. A score of less than or equal to 2 was classified as low grade lesion indicating of human papillomavirus (HPV) infection or cervical intraepithelial neoplasia (CIN)1. Intermediate grade was 3 to 5 indicating of CIN2 while, high grade lesion as a reflection of at least CIN3 is 6 to 8. Colposcopic directed biopsy on all lesions were performed for histopathologic examination. Results: The strength of agreement with Spearman rank correlation was 0.69. Sensitivity, specificity, positive and negative predictive value for differentiate high from low grade lesion were 91.7%, 66.7%, 64.7% and 92.3%, respectively. The overall accuracy of modified RCI after adjusted was 76.7%. Accuracy in a subgroup of low and high grade lesion were 92.3% and 64.7%, respectively. Conclusion: Modified Reid&rsquo;s colposcopic index had a good positive correlation to cervical histopathology and also had high accuracy to differentiate low from high grade lesion. Keywords: Modified Reid&rsquo;s Colposcopic Index; Colposcopic directed biopsy; Colposcopy; Intraepithelial cervical neoplasia

Cervical Intraepithelial Lesions in Women with Persistent Inflammatory Smear on Pap Smear: A Descriptive Cross-sectional Study.

Persistent inflammatory smear is a benign finding on pap test but is associated with premalignant lesion of the cervix. Further evaluation is therefore necessary. This study was done to determine the prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear. This is descriptive observational study conducted in Department of Obstetrics and Gynaecology of tertiary care centre of Nepal from 15th May 2020 to 14th May 2021 after obtaining ethical clearance from Institutional Review Board (Reference no MEMG/IRC/338/GA). Women with two consecutive pap smear reports showing inflammatory findings were enrolled. Colposcopy was performed and Modified Reid's colposcopic index was used to grade the lesions. Colposcopic guided biopsy was taken and tissue sent for histopathology for abnormal colposcopic lesions. Data analysis was done using Statistical Package for Social Sciences version 21 and frequency and percentages were used to present data. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 115 women, 57 (49.5%) at 95% Confidence Interval (40.37-58.63) had Cervical Intraepithelial lesions. Among them 48 (41.7%) had low grade intraepithelial lesions and 9 (7.8%) had high grade lesions on colposcopy. The prevalence of cervical intraepithelial lesions in women with persistent inflammatory smear on pap was higher in our study compared to other studies.

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Purpose : Aim of our study is to compare the colposcopic findings with the histopathologic results of atypical squamous cells of undetermined significance (ASCUS) diagnosed during cervical cytological screening in patients applied with various complaints and evaluated with co-test so as to to determine the clinical value of it. Materials and Methods: In this retrospective analysis 177 patients who attended between January 2011 and may 2020, aged between 24-74 years, with the result of ASCUS in their Pap smear tests, were enrolled. Colposcopic findings of cases were classified according to Reid Colposcopic Index (RCI) and compared with the histopathologic results. Results: 177 patients were analyzed and the mean age of them was 37,1±1,41 (24-74), parity 2,8±1.07 (0-11) and mean smoking was found to be 6 cigarettes/day (0-40 cigarettes/day). 148 (%83,6) of cases were in premenapouse, 29 (%16,3) of them were in postmenapousal period. 68 (%38,4) patients were diagnosed as chronic cervicitis by colposcopy assisted cervical biyopsy, rest 108 (%61,0) were determined as cervical intraepithelial lesions (CIN) [85 (%48) CIN 1, 16 (%9) CIN 2, 7 (%3,9) CIN 3] and 1(%0,5) patient was found to be cervical carcinoma (CX CA). Comparison between HPV DNA types and RCI with biopsy results was analyzed with Pearson Exact Chi-square test and found to be statistically significant between groups (p<0.001). Conclusion: Our results put forth that colposcopic evaluation is needed in patients with cytologic ASCUS results even if HR-HPV DNA test is negative. That's why Pap smear test cannot be replaced by screening only with HR-HPV DNA, co-test requirement showed to be more suitable because of cytologic evaluation involvement.

Comparison of Punch Biopsy and Loop Biopsy for the Management of Severe Cervical Intraepithelial Neoplasia (CIN).

The study was undertaken for comparing the colposcopy directed punch versus loop excision biopsy technique in order to get the most précised sample for study as well as comparing the complications associated with them. The prospective clinical study was conducted on 50 women of age group 20-80years. Women who were found to have a Reid colposcopic index of high grade disease, low grade disease or invasive disease recognized as the patients needed biopsy. They were randomly divided into either the punch biopsy forceps group (PB group) or the round loop electrode group (LE group). The quality of tissue of the LE group was found significantly better than the tissue quality of PB group based on the size, site and tissue damaged measures. Both the groups were found to have the same cytology report as well as colposcopic diagnosis and histology reports. Mild degree of bleeding has been reported as a frequent complication in LEEP and punch biopsy. The VAS pain score associated in each procedure was found to be 2.4 and 2.8, respectively, in both groups with no significant difference. The present study has concluded that the quality of tissue from the LEEP biopsy electrode was better than the punch biopsy forceps with no difference in the pain score, and it could be suggested that use of the round loop electrode in CDB provides good quality tissue to evaluate the histology.

A comparative study between Reid’s colposcopic index score and Swede score in women suspected of cervical cancer

A comparative study between Reid’s colposcopic index score and Swede score in women suspected of cervical cancer

Diagnostic accuracy of colposcopic examination in patients with oral dysplastic lesions

Colposcopy is a direct microscopic method and is the gold standard tool to detect early cervical dysplastic lesions. In the past, many attempts have been made to use gynecologic methods to examine the oral mucosa. The aim of this study was to detect the diagnostic accuracy of oral colposcopy in diagnosing oral dysplastic lesions in comparison with microscopic evaluation based on biopsy and compare Reid's Colposcopic Index (RCI) and the Swede scoring system in diagnosing oral dysplastic lesions. Twenty-five patients who presented for diagnosis of oral leukoplakia to the Oral Medicine and Periodontology Department, Faculty of Dentistry, Cairo University (Cairo, Egypt) and met the selection criteria were recruited in this study. Each patient was subjected to colposcopic examination, followed by biopsy to confirm the results of colposcopy. The sensitivity and specificity of oral colposcopy were calculated after colposcopic assessment by using the Swede scoring system and the RCI. The diagnostic accuracy of oral colposcopy with use of the Swede scoring system was superior to that of oral colposcopy with the use of the RCI. Colposcopic examination using the Swede scoring system is very specific for diagnosing oral epithelial dysplasia and for using the "see-and-treat" method, whereas the RCI is a very sensitive screening method for the diagnosis of oral epithelial dysplasia in oral potentially malignant disorders.

Comparison of Visual-Based Cervical Cancer Screening Tests with Pap Smear in a North Indian Tertiary Centre: A Prospective Randomised Observational Study

Cervical cancer is the second leading cause of female cancers in India. Considering the latency of the disease, screening of precancerous lesions of cervix forms a key aspect of disease prevention and control. Limited research has been conducted in the region of Uttarakhand where estimated incidence of cervical cancer is quite significant. There is no provision available for mass or regular screening for cervical cancer in the state as well. With this background, the present study was planned to compare the diagnostic accuracy of visual-based methods with conventional Pap smear in order to provide an affordable and feasible screening modality in the subserved population of hilly terrains of Uttarakhand. In the present study, we aim to study the comparability of diagnostic accuracy of visual-based screening tests (VIA, VILI) and Pap smear. Total 195 consenting participants were recruited from Gynaecology OPD, AIIMS Rishikesh from January to December 2018. All participants were subjected to standard Pap smear testing and then randomly allocated to 3 groups namely (A) Pap smear only group, (B) VIA group and (C) VILI group. Colposcopy was performed on all the participants as a standard diagnostic test to confirm the screening test findings keeping the cutoff as CIN 2 + lesions in the three groups, and guided biopsy was performed on those with Reid’s Colposcopic Index (RCI) ≥ 6. Observations were analysed using OpenEpi Version 7.0 software to compute the tests of validity for individual screening tests and combination of visual tests with Pap smear. The tests of validity for VIA, VILI, and Pap smear were as follows: sensitivity of, 50%, 50%, 25%, specificity of 95%, 98%, 95%, for VIA, VILI, and Pap smear, respectively. Diagnostic accuracy was 92.3%, 92.31%, and 90% for VIA, VILI and Pap smear, respectively. Visual-based screening tests demonstrated comparable accuracy as Pap smear. All three screening tests had diagnostic accuracy to the tune of 90%. Thus visual tests can be used in resource poor settings to screen cervical cancer where Pap smear is not feasible logistically without compromising accuracy.

The Diagnostic Efficacy of Swede Score for Prediction of Pre-invasive Cervical Lesions: A Prospective Hospital-Based Study.

The accuracy of colposcopy has recently been called into question particularly with regard to determining the site requiring biopsy. The technique of colposcopy is largely operator dependent, and the agreement between colposcopists is less reliable than once presumed. In an attempt to standardize colposcopy a new scoring system, the Swede score has been devised, which includes lesion size as a variable to be scored in addition to the 4 variables found in the modified Reids Colposcopic Index (RCI). To assess the diagnostic accuracy of Swede score for pre-invasive cervical lesion. A cross-sectional study in a tertiary care centre. Swede score was calculated for assessment of pre-invasive cervical lesions on patients undergoing colposcopy who were suspected with pre-invasive cervical lesion. Cervical biopsy was taken if modified RCI ≥ 3 or Swede score ≥ 5. Histopathology report of the cervical biopsy was taken as gold standard. Swede scores of 5 or more had sensitivity, specificity, positive and negative predictive values of 94.9%, 88.4%, 75.5% and 92.9% respectively. The Swede score by just incorporating one additional variable that is size of the lesion, showed better correlation with histopathology.

A comparison of the associations of Reid Colposcopic Index and Swede Score with cervical histology

Cervical cancer, the fourth most common cancer in women, is preventable. Colposcopy and colposcopic scoring systems are helpful tools to guide the treatment of precancerous lesions. This study was done to compare the association between Reid colposcopic index (RCI) and Swede score. This prospective study enrolled 159 subjects aged 18 years or over with abnormal pap smears or high-risk HPV (types 16 and/or 18). All women underwent colposcopies, and the findings were classified by RCI and Swede score. Biopsies were done in all cases. The performance of both scores was evaluated. A total of 43 (27.0%) high-grade lesions were detected. AUC of ROC of both tests showed excellent performance with 0.906 for RCI and 0.902 for Swede score. The correlation coefficient was 0.986. At a cutoff of 5, RCI had a sensitivity, specificity, positive predictive value, and negative predictive value for detected CIN2+ lesions of 83.7%, 89.7%, 75.0%, and 93.7%, respectively. At a cutoff of 7 for RCI score, the corresponding figures were 46.5%, 99.1%, 95.2%, and 83.3%. At a cutoff of 5, Swede score had a sensitivity, specificity, positive predictive value, and negative predictive value of 88.4%, 87.1%, 71.7%, and 95.3%. At a cutoff of 9 for Swede score, those values were 14.0%, 99.1%, 85.7%, and 75.7%. There was a good association between RCI and Swede score. Both scoring systems had the good performance. Swede score is effective for practical use and applied in Thailand.

Study of the Correlation of Diagnostic Efficacy of Modified Reids Colposcopic Index with Colposcopic Results

Study of the Correlation of Diagnostic Efficacy of Modified Reids Colposcopic Index with Colposcopic Results

Colposcopic scoring indexes in the evaluation of cervical lesions with the cytological result of atypical squamous cells, cannot exclude high-grade lesion.

Colposcopic indexes including Reid index and Swede score were developed to make the colposcopy more objective. The aim of our study was to evaluate the significance of colposcopic indexes in the evaluation of ASC-H cervical lesions. We carried out a cross-sectional study in the Clinic of Obstetrics and Gynecology between January 2013 and December 2018. The study included 535 women, from which 66 women had a cytological result ASC-H. Scoring of all colposcopic findings was assessed according to Reid modified index and Swede score and a composite score was determined. Frequency distributions were compared using χ2 /Fisher exact test. Spearman rank correlation coefficient was computed between RCI and Swede score. Sensitivity, specificity, positive and negative predictive value and positive likelihood ratio of modified Reid colposcopic index at a cutoff of ≥4 for the detection of HSIL+ lesions were: 86.11% (95% CI: 70.5-95.3), 83.33% (95% CI: 65.3-94.4), 86.11% (95% CI: 69.7-94.8), 83.33% (95% CI: 64.5-93.7) and 5.17 (95% CI: 2.3-11.6). Swede score with the cutoff value ≥5 showed comparable results to modified Reid index with the increased sensitivity: 94.44% (95% CI: 81.3-99.3). ASC-H category represents the trickiest cytological diagnosis as it is underlined with the high risk of severe cervical dysplasia. Evaluating the cervical lesion by the use of colposcopic indices helps the gynecologist to objectively evaluate all the pathologies of uterine cervix. Swede score with the cutoff value 8 also enables a 'see and treat' option in management of atypical squamous cells, cannot exclude high-grade lesions.

Replacing Iodine Staining with Size of Lesion: The Performance of Modified Reid Colposcopic Index.

Aim:This study of diagnostic accuracy aimed to assess the performance of authors’ proposing colposcopic index for detecting histological diagnosis of cervical intraepithelial neoplasia grade 2 or worse (CIN2 or worse). Methods:Retrospective analysis of data was carried out on medical records of women who underwent colposcopy in Rajavithi hospital from January 2007 to December 2014. The authors’ proposed score included the first 3 criteria of RCI (margin, color, vascular pattern) and replacing the last RCI criterion (iodine staining) with the detail of size and location of a lesion which was retrospectively retrieved from medical records. Total score for detecting any lesion was ranged from 0-8, similar to the RCI. Performance of the score was assessed for sensitivity, specificity, and positive and negative predictive values at every cut-off level. Results:Among 207 eligible women, 87 (42%) had CIN2 or worse. Cut-off level of score ≥ 6 had a sensitivity, specificity, and positive and negative predictive values of 54.0%,97.5%,94.0%,74.5%, respectively while cut-off value ≥ 2 had sensitivity , specificity, positive and negative predictive values of 94.2% ,55.8% ,60.7%, and 93.0%, respectively, for histological diagnosis of CIN 2 or worse. The area under ROC curve was 0.88. In women with type 3 T-zone, the area under ROC curve was 0.94 which was excellent. Conclusion:The performance of the colposcopic score that replaces iodine staining with the size and location of the lesion is good and practical. High cut-off level can be used in see and treat approach for high-grade squamous intraepithelial lesions. Low cut-off level may be used for omitting biopsy in case of low grade impression. This scoring system seems to have greater performance in womens with type 3 T- zone.

Discrepancy between colposcopy, punch biopsy and final histology of cone specimen: a prospective study.

Τo estimate the discrepancy rate between colposcopy, punch biopsy histology and surgical specimen histology as well as the positive (PPV) and negative predictive value (NPV) of colposcopic diagnosis for high-grade squamous intraepithelial lesions (HGSIL). A prospective study was conducted during the period of 2012-2016. Αll cases in which surgical treatment had been applied and histopathological diagnosis of those surgical specimens was available were included. Cases in which ablation was performed and cases with incomplete data or conservative approach were excluded. Primary outcome was the agreement rate between histologic diagnosis of surgical specimen, histologic diagnosis of punch biopsy and colposcopic diagnosis according to REID Colposcopic Index. PPV and NPV of colposcopy and biopsy to diagnose HGSIL were also assessed. Τhere were 120 cases meeting our inclusion criteria, while biopsy was obtained in 104 cases. Mean age of women was 32.7±9.0. Colposcopic diagnosis was CIN2 in 65 cases, CIN3 in 11 cases, CIN1 or less in 44 cases. Τhe level of agreement was fair between colposcopy-surgical specimen histology (κ value 0.443), fair between colposcopy-punch biopsy (κ value 0.34) and moderate between punch biopsy-cone specimen histology (κ value 0.443). PPV of colposcopy to detect HGSIL was 72.3%, while NPV was only 47.7%. Punch biopsy and surgical specimen histology present the highest agreement between the different diagnostic procedures. Colposcopy presented satisfying PPV for HGSIL cases, but its NPV was poor. In contrary, punch biopsy was characterized by both satisfying PPV and NPV for HGSIL cases.

Correlation of Two Colposcopic Indices for Predicting Premalignant Lesions of Cervix.

Cervical cancer is the second most common malignancy among women in India, mainly affecting the females of Peri-Menopausal age group. Colposcopy has been very useful for diagnosing cervical cancer to guide the biopsy. Reids and Scalzi proposed the Reids Colposcopic Index (RCI) to make colposcopic diagnosis less subjective, which is currently the most accepted scoring system. Recognizing the correlation of size of the lesion with likelihood of harbouring high grade disease, a new scoring system, the Swede score, has been devised by Strander et al in 2005. In present study we compared the Reids colposcopic index with Swede score. From the present study it is evident that Swede score of 8 or more has 100% specificity and can be used for performing direct excisional procedure as a “see-and-treat” method at this cut-off. This may be the preferred method for the treatment of high-grade CIN because it reduces the number of visits to the clinic and failure to receive treatment.