Colposcopic evaluation of pre-invasive and early cervical carcinoma with histologic correlation.

This observational study was done in Colposcopy clinic of Mymensingh Medical College Hospital, to evaluate the accuracy of colposcopic assessment of pre-invasive and early cervical carcinoma comparing with the reference standard of histology, in order to evaluate the justification of colposcopic examination. This study included 227 VIA (visual inspection of cervix with application of 5% acetic acid) test positive patients, who were referred to us for colposcopic evaluation during a period of January 2011 to June 2011. Patient with clinically evident of invasive cervical carcinoma were excluded from this study. VIA test was performed again in all patients prior to systematic colposcopic examination and it was found that 72.6% patients had abnormal colposcopic findings (p<0.05). Directed punch biopsy specimen was taken only from abnormal colposcopic appearances and then it was send for histopathological examination. Records of all available biopsy results were recorded. Correlation of colposcopic impression with colposcopy guided biopsy results was compared. Among 79 colposcopically diagnosed Low-grade Squamous Intraepithelial Lesions (LSIL) or low-grade Cervical Intraepithelial Neoplasia (CIN I) cases, 22.8% cases were chronic cervicities, 69.6% were LSIL (CIN I) and 7.6% were High-grade Squamous Intraepithelial Lesions (HSIL) and among 38 HSIL(CIN II/CIN III) cases, 7.8% were found to chronic cervicities, 31.6% were LSIL and 60.5% were HSIL. Fifteen cases of colposcopically diagnosed preclinical invasive carcinoma were confirmed by histopathology (p<0.05). The rate of false positive is higher in the diagnosis of HSIL than LSIL (39 vs. 30%); on the other hand the rate of false negative was higher in LSIL (9 vs. 4.5%). The sensitivity of colposcopic diagnosis of pre-invasive cervical carcinoma was ranging from 79-82% and specificity ranged between 73-87%. Positive predictive value was 62% for HSIL and 70% for LSIL and the colposcopic accuracy was 91% and 95% for the diagnosis of LSIL and HSIL respectively. All the statistical results were 100% for the diagnosis of preclinical invasive carcinoma. This study showed that colposcopy is a valid tool for the detection of pre-invasive and early cervical carcinoma. It can be considered as a secondary testing tool for VIA positive women.