Publication:

Concurrent cytologic and colposcopic evaluation of symptomatic cervical erosion

Background Cervical cancer is amongst the leading causes of deaths due to cancer in developing countries. Moreover, preinvasive lesions of the cervix have a long latency period for conversion into malignancy and are also detectable by screening techniques. Hence, colposcopy in addition to cytology should be carried out wherever facility is available to ensure early detection and timely management.

Methods Simultaneous cytology and colposcopy was done for 80 women with symptomatic cervical erosion followed by a colposcopic directed biopsy in women with MRCI >3. Finally, correlation between cytology, colposcopy and histopathological results was done.

Results 65/80 women were biopsied. 12/80 women had MRCI >6 amongst which 10/80 were confirmed to have a high grade lesion on histopathology. 13/80 had lesser abnormalities (ASCUS and LSIL) amongst which 3/80 had CIN1 on histopathology. Only 2/80 had HSIL on cytology as compared to 8/80 on histopathology that had CIN 2/3. Lastly, only 1/80 had SCC on cytology compared to 2/80 on histopathology. The sensitivity, specificity, PPV and NPV of cytology and colposcopy for diagnosing cervical dysplasia was 46.1%, 83.5%, 35.2%, 88.8% and 84.6%, 86.5%, 55%, 96.6% respectively making colposcopy a better screening tool than cytology for evaluating cervical malignancy.

Conclusions Colposcopic examination should ideally be carried out in all women with symptomatic cervical erosion in addition to cytology. Moreover, suspicious areas should be biopsied even if cytology is normal to exclude malignancy.