Evaluation of Colposcopy Using Swede Score in Screening of Cervical Cancer

Abstract

BACKGROUND Cervical cancer is a global health problem. It ranks as the 4 th leading cause of female cancer in the World, (1) the 2 nd leading cause of female cancer in India and the 2 nd most common female cancer in the women aged 15 to 44 years in World (1) and India. About 527,624 new cases are diagnosed and 265,672 cervical cancer deaths occur annually in the World. Incidence and prevalence of cervical cancer remains high in developing countries due to lack of resources, lack of effective screening programmes and poorly organised health system aimed for detecting precancerous condition before they progress to invasive cancer.Colposcopy remains the reference standard for assessing the validity of all the screening procedures for cervical cancer. Colposcopy scoring systems provide an objective diagnosis to grade the severity of premalignant lesions and select patients who require treatment. A new scoring system, Swede score, has added lesion size as a parameter.Objective-This study aimed to evaluate the diagnostic efficacy of colposcopy using Swede score and to determine the degree of correlation between colposcopy impression and histopathology. women aged 20 to 65 who met the selection criteria were included in the study. All women underwent colposcopy; the findings were scored by Swede score, biopsy taken from the abnormal areas. Patients in whom colposcopy was normal, biopsy was taken from the cervix within the transformation zone. RESULTSAccording to the Swede scoring system, 133 (60.45%) were benign cases, 64 (29.1%) women were diagnosed as LGL, 23 (10.45%) were diagnosed as HGL. As far as histologic results were concerned, 144 (65.45%) were benign showing chronic cervicitis, whereas 52 (23.64%), 24 (10.9%) were diagnosed as CIN 1 (LGL), HGL (CIN 2, CIN 3) respectively. CONCLUSIONThe 'k' value for the strength of correlation between colposcopy impression for CIN using Swede score and histopathology was k=0.73, for CIN 2+ it was k=0.92. Colposcopy by Swede score had a satisfactory sensitivity of 89.47% and specificity of 86.81% in the detection of CIN. Whereas in the detection of high-grade CIN (CIN 2+), Swede score colposcopy had a sensitivity of 91.67% and specificity of 99.49%.

Efficacy of the Swede score in prediction of high-grade lesions of cervix

“…26 Penumalli et al reported in their study that according to histopathology, 144 (65.45%) were benign, showing chronic cervicitis, whereas 52 (23.64%) and 24 (10.9%) cases were diagnosed as CIN 1 (LGL) and HGL (CIN 2, CIN 3) respectively. 28 Biopsy was normal in 16 (3.0%) women. 31 Penumali et al did another study on 220 women and found that 52 (26.64%) and 24 (10.9%) were diagnosed with CIN1 and CIN2, 331.…”

“…26 The median (IQR) age at the first marriage of the patients was 17 (15)(16)(17)(18) years (range: 13-27), and the age at the first delivery of the patients was 19 (17)(18)(19)(20) years (range: 15-29). 28 Penumalli et al reported that the mean age at marriage was 19.2 years; 76.8% (n=169) had their marriage by 20 years. The 50.5% (111) had >25 years of married life.…”

“…A Swede score of 4.5 or greater had best combination of sensitivity and specificity for CIN 2, with AUC of 0.966 (95% CI, 0.927-1.00) corresponding to a sensitivity of 100% and specificity of 90% (Figure 3). 28 The majority (36.3%) had a primary level of education and were Muslim (82.5%). Most patients (52.5%) were from the lower middle class.…”

“…In their study by Penumalli et al, colposcopy was done for leucorrhoea in 132 women, comprising 60%. 28 Further reasons for which colposcopy was done were unhealthy cervix 26.8% (59), abnormal Pap 9.1% (7), postictal bleeding 3.2% (2), and intermenstrual bleeding 0.9% (20). Ninety-five had inflammatory Pap smear contributing 43.25%, followed by ASCUS in 64 (29.1%) study participants.…”

“…4 Due to a lack of resources, efficient screening programs, and a poorly structured health system focused on recognizing precancerous conditions before they proceed to an invasive malignancy, cervical cancer's incidence and prevalence remain high in developing nations. 5 Most (87%) of women diagnosed with cervical cancer live in developing countries. 6 India accounts for one-fourth of the global burden of cervical cancer cases.…”