Colposcopic scoring indexes in the evaluation of cervical lesions with the cytological result of atypical squamous cells, cannot exclude high‐grade lesion

Abstract

Aim: Colposcopic indexes including Reid index and Swede score were developed to make the colposcopy more objective. The aim of our study was to evaluate the significance of colposcopic indexes in the evaluation of ASC-H cervical lesions. Methods: We carried out a cross-sectional study in the Clinic of Obstetrics and Gynecology between January 2013 and December 2018. The study included 535 women, from which 66 women had a cytological result ASC-H. Scoring of all colposcopic findings was assessed according to Reid modified index and Swede score and a composite score was determined. Frequency distributions were compared using χ 2 /Fisher exact test. Spearman rank correlation coefficient was computed between RCI and Swede score. Results: Sensitivity, specificity, positive and negative predictive value and positive likelihood ratio of modified Reid colposcopic index at a cutoff of ≥4 for the detection of HSIL+ lesions were: 86.11% (95% CI: 70.5-95.3), 83.33% (95% CI: 65.3-94.4), 86.11% (95% CI: 69.7-94.8), 83.33% (95% CI: 64.5-93.7) and 5.17 (95% CI: 2.3-11.6). Swede score with the cutoff value ≥5 showed comparable results to modified Reid index with the increased sensitivity: 94.44% (95% CI: 81.3-99.3). Conclusion: ASC-H category represents the trickiest cytological diagnosis as it is underlined with the high risk of severe cervical dysplasia. Evaluating the cervical lesion by the use of colposcopic indices helps the gynecologist to objectively evaluate all the pathologies of uterine cervix. Swede score with the cutoff value 8 also enables a 'see and treat' option in management of atypical squamous cells, cannot exclude high-grade lesions.

Value of high‑risk human papillomavirus detection combined with colposcopy in the diagnosis of cervical cancer and precancerous lesions

“…Under colposcopy, white acetic acid epithelium, with the severity of the lesion positively associated with the whiteness of the epithelium, white glands and rings, heterogenous vessels and punctured vessels were observed. The Reid colposcopy index (RCI) score was proposed by Reid in 1984; it can reduce the subjectivity of colposcopy diagnosis and is currently the most widely accepted colposcopy scoring system ( 26 ). Previous studies ( 27 , 28 ) reported that colposcopy diagnosis using RCI has a good consistency with histopathological diagnosis.…”

Visual appearance of the uterine cervix differs on the basis of HPV type status in high-grade squamous intraepithelial lesion: the results of a reliable method

“…account for 30% [ 4 – 7 ]. Currently, colposcopy-guided biopsy with histopathology is considered the gold-standard method for the diagnosis of cervical cancer and cervical intraepithelial neoplasia [ 8 , 9 ]. By applying acetic acid (3–5%) and Lugol’s iodine, a colposcopist can detect abnormalities in cervical visual appearance based on changes in the epithelium and blood vessels [ 10 ].…”

Visual Appearance of the Uterine Cervix Differs on the Basis of HPV Type Status in High-Grade Squamous Intraepithelial Lesion: The Results of a Reliable Method

“…account for 30% (4)(5)(6)(7). Currently, colposcopy-guided biopsy with histopathology is considered the gold-standard method for the diagnosis of cervical cancer and cervical intraepithelial neoplasia (8,9). By applying acetic acid (3-5%) and Lugol's iodine, a colposcopist can detect abnormalities in cervical visual appearance based on changes in the epithelium and blood vessels (10).…”