Role of Colposcopy in the Evaluation of Unhealthy Cervix and Cervical Intraepithelial Neoplasia

Author(s): Rujuta Parimal Fuke1 , Mangala Sonak2 , Monika Singh3

BACKGROUND Invasive cancer of cervix is preventable because it has a long pre-invasive phase, cervical cytology screening is possible, and the treatment of pre-invasive lesions is effective. There are various methods available for screening of cervical precancerous and cancerous lesions like Visual Inspection by Acetic Acid (VIA), Visual inspection by Lugol’s Iodine (VILI), conventional pap smear, liquid based cytology, colposcopy and HPV DNA testing. But, negative cytology does not rule out cervical intraepithelial lesions (CIN) completely. In this study we have studied patients with symptoms, abnormal appearing cervix, and patients with abnormal cytology by colposcopy to detect intraepithelial neoplasia of cervix. METHODS In this cross-sectional observational study of 149 subjects, women attending outpatient department of Obstetrics and Gynaecology who were symptomatic for recurrent and persistent vaginal discharge, postcoital bleeding, menstrual abnormalities were examined by per speculum examination and cervical cytology obtained. In indicated patients, colposcopy was done and colposcopic directed biopsy of lesions was taken for evaluation and the results compared. RESULTS Colposcopy showed accurate estimation in 57.89% cases, over estimation in 36.84% cases and under estimation in 5.26% cases. Sensitivity of colposcopy in our study was 98.30%. Specificity of colposcopy in present study was 57.30%. Positive predictive value of colposcopy in our study was found to be 68.75%, negative colposcopy value was 96.66%. Prevalence of CIN in our study group was found to be 39.43%. CONCLUSIONS Colposcopy was found to be useful in understanding the morphology of the cervical lesions, both of the benign and neoplastic and this was very helpful in planning their management. In spite of less specificity and less positive predictive value in our study, a detailed colposcopic evaluation of cervix with a guided biopsy is recommended as an important diagnostic method for the detection of precancerous lesions and early cervical cancer.