ABSTRACT
Background: Introduction-carcinoma of cervix is the commonest cancer in Indian women. It constitutes 14%of the total population above age of 50 years. Atrophic changes in the genital tract causes problems in Pap smear as well as in the colposcopy.Methods: This is prospective observational study conducted in the department of obstetrics and gynecology of SGRDIMSR, Sri Amritsar, which comprised 30 cases of postmenopausal women referred for colposcopy. Inclusion criteria were complaints of post-menopausal bleeding, abnormal vaginal discharge, post coital bleeding, an abnormal PAP smear, an unhealthy-looking cervix. Women with history of any surgery on the cervix in the past three months or with obvious cervical cancer were excluded.Results: Patient with age group of 44-70 years were included, and maximum number of patients had complaint of post-menopausal bleeding (50%). 9 (30%) patients were positive for malignancy on histopathology, while with 9 (30%) false positive patients on colposcopy. Problems encountered while performing colposcopy includes cervix flushed with vagina, atrophy of introitus, bleeding from the cervix and relaxed vaginal walls. Use of various corrective measures were helpful to overcome the problems of colposcopy.Conclusions: It is an essential part of cervical screening programme, but it has some limitations and pitfalls which can lead to error in the diagnosis.
ABSTRACT
Background: Cervical carcinoma is the second most common malignancy amongst women in India. It is regarded as a public health problem and a priority in cancer control programmes by the WHO. Colposcopy has proven to be very useful in identifying and guiding the biopsy of dysplastic lesion. To minimize inter-observer variation, colposcopic scoring system has been introduced.Methods: A prospective cross- sectional study including 250 women in whom the prevalence of different grades CIN was done. Co-relation of Pap (cytology) with colposcopy scoring system viz. Reid’s and Swede scores, has been made in this study. The two screening methods were compared and their statistical association with histological findings were analyzed.Results: Per speculum examination performed in 250 sexually active women with suspicious looking cervix, belonging to 25-60 years of age, with most common presenting complaints of pain abdomen (38.8%) followed by leucorrhoea, irregular cycles and Post coital bleed. Unhealthy cervix (49.2%) and persistent discharge (28%) were the most common indications for colposcopy. An assessment of both SWEDE score and Reid score as a function of histological findings was done, while Swede score of >5 showed slightly more sensitivity (100%) for diagnosing CIN1+ lesions, Reids score of >5 was more specific (100%) with a higher positive predictive value (100%) for diagnosing CIN 1, 2, 3 and invasive cervical carcinoma. There was a marked positive association between Reid score and SWEDE score.Conclusions: The colposcopic scoring systems and histopathology showed significant compliance. Predictive accuracy of colposcopy increased with increasing severity of disease.