Publication:

The utility of colposcopy in detecting relapse after treatment of gynaecological malignancies

Background Vaginal bleeding is the most common symptom of vault relapse in gynecological cancers. This symptom may be overlooked or attributed to other causes, such as atrophy, infection, or post-radiation changes. Colposcopy allows direct magnified visualization of vaginal mucosa and abnormal vasculature though its role in detecting relapse is unclear.

Methods It is a retrospective observational study of 31 patients who were referred for colposcopy and biopsy with complaints of abnormal vaginal bleeding during follow up of endometrial or cervical cancer.

Results Among 31 patients, 19 patients were diagnosed to have primary cervical cancer and 12 endometrial cancers. Primary treatment was surgery alone (n=10, 32.2%), chemo-radiation alone (n=4, 12.9%) and both (n=17, 54.8%). Abnormal colposcopic findings were atropic features (n=21, 67.7%), radiation changes (n=8, 25.8%), erosion (n=9, 29.0%), acetowhite areas (n=9, 29.0%), abnormal vessels (n=8, 25.8%) and iodine staining abnormality (n=16, 51.6%). According to Swede scoring system, 77.1% (n=24) were normal or low grade lesions, 22.6% (n=7) were high grade lesions.  Total of 6 recurrence cases identified out of which 5 cases had high grade (Swede score >7) and one had low grade (Swede score 5-7) colposcopic features. On taking Swede score cut off of 5 or more, the sensitivity of colposcopy in detecting vault recurrence is 100%, specificity 96%, positive likelihood ratio of 25%and negative likelihood ratio of 0%. Overall the accuracy of colposcopy in detecting relapse was 96.8%.

Conclusions In our experience colposcopy is worth in detecting the cause of abnormal vaginal bleeding after treatment for endometrial and cervical cancer. Swede score is a good measure to decide on taking biopsy among these patients. Furthermore, larger studies are needed for better clarification.