Comparison of Colposcopic and Histopathologic Interpretations among Patients Undergoing Screening for Cervical Cancer at MTRH Cervical Dysplasia Clinic.

Background

Colposcopy is the examination of the epithelia of the cervix, lower genital tract, and anogenital area using magnified illumination after the application of specific solutions to detect abnormal appearances consistent with neoplasia, or to affirm normality. Integral to the procedure is targeting biopsies to areas of greatest abnormality. There are four basic colposcopic diagnoses: (i) Normal, (ii) low-grade disease (HPV infection/CIN 1), (iii) high-grade disease (CIN 2 or CIN 3), and (iv)invasive cancer. Colposcopic grading systems e.g. Reid and Swede have been developed to provide an objective, accurate, reproducible, and clinically meaningful prediction of the severity of CIN lesions based on discriminatory analysis of specific colposcopic signs.

At the MTRH cervical dysplasia clinic, colposcopy is usually performed when the cervix is clinically abnormal or suspicious on naked-eye examination. Some patients are also referred to the clinic with abnormal cervical pap smears and unexplained, persistent vaginal discharge for assessment by colposcopy to exclude a neoplastic cause. Other indications include vulvar or vaginal neoplasia, or condylomataacuminata. A few pregnant patients have also been referred during which the colposcopic procedure is modified with a less liberal use of biopsy in the absence of warning signs of high-grade disease or cancer, and avoidance of endocervical curettage.

The biopsy specimen obtained during colposcopy are all submitted for histopathological interpretation.

Rationale

Routine determination of a colposcopic diagnosis has permitted quality control measures to be implemented in colposcopy. In colposcopic quality control programs, one is required to achieve for at least an 80% accuracy rate in colposcopic–histologic correlation or receive remedial training in colposcopic assessment of cervical lesions.

Broad Objective

To determine the Colposcopic- Histologic correlation among patients undergoing colposcopic evaluation at MTRH cervical dysplasia clinic.

DESIGN:

Prospective clinical study.

SETTING AND POPULATION:

Women undergoing colposcopic investigation at MTRH cervical dysplasia clinic because of because of atypical cervical cytology, dysplastic biopsy changes or pathological appearance of the cervix.

METHODS:

Colposcopic variables (acetowhiteness, margins plus surface and configuration,vessel patterns, and iodine staining) will be determined and scored using the Modified Reid Colposcopy Index(RCI) scores of 0,1 and 2 for each variable and an additional variable being suspicious for cancer/AIS.

Overall RCI score i.e. 0-2 (Likely to be CIN1), 3-4 (Overlapping lesion likely CIN1/2), 5-8(likely to be CIN 2/3), Suspicious for cancer and AIS will be assigned for each patient.Colposcopically directed biopsies will be taken from the lesions.

Histology will be compared with the colposcopic diagnosis. Sensitivity and specificity will calculated for each variable, and the combination of all five variables, with high-grade lesions (i.e. cervical intraepithelial neoplasia (CIN2, CIN3 or adenocarcinoma-in-situ (AIS)) as endpoints.

MAIN OUTCOME MEASURES:

Colposcopic score (Reid) and histology (CIN1, 2, 3; AIS; cancer)

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