Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesion : a four - year experience in Hospital University Sains Malaysia
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Date
2001-11
Authors
Mohamed Tarmizi, Mohamed Hatta
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
OBJECTIVE: To evaluate the diagnostic accuracy of cytology and
colposcopy in women with cervical intraepitheliallesion using histology as the
'gold standard'. We aim to determine the sensitivity, .specificity, positive and
negative predictive values of cytology and/or colposcopy against histology in
determining high-grade lesions. Secondly, to identify the possible risk factors
for abnormal cytological smear of high-grade lesions in the population studied.
STUDY DESIGN: A four-year cross sectional study from June 1997 to May
2001 was conducted in 112 women with abnormal cervical cytology who had
undergone colposcopic examination in Hospital University Sains Malaysia.
The correlation between cytology and colposcopic impression to
colposcopically directed biopsy were analysed. The correlation was accepted
accurate when both reports were either the same as histopathological
diagnosis.
RESULTS: The sensitivity of cytology for detecting high-grade lesions was
60o/o and the specificity was 85.4o/o while the positive predictive value 76.9°/o
and negative predictive value 72.2°/o. The sensitivity for colposcopy to detect
high-grade was 72.0°/o, and the specificity 82.2°/o. The positive predictive
value was 76.9% while negative predictive value was 78.4o/o. When in
combination, the sensitivity increased tq 74.2o/o but the specificity was 82°/o.
For patients with history of more than one sexual partner, the risk of developing high grade lesion was 4.3 (95°/oCI [1. 7 to 11.1], p= 0.013) and
those with husbands with more than one sexual partners, there was an
increase risk of developing high grade lesion of 2. 6 (95o/oCI [1.1 ·to 6.1 ],
p=0.02). After eliminating the confounders, in patients with history of more
than one sexual partner, the risk of developing high-grade lesion was 1.4
(95°/oCI [0.4 to 8.6], p= 0.003) and multiple sexual partners of the spouse was
1.2 (95%CI [0.4-2.0], p= 0.02).
In our study, the incidence of high-grade lesions (confirmed by
histopathology) in persistent CIN1 smears was relatively high (41.2°/o) while
for CIN 2 (68.4%) and CIN 3 (78.9o/o) respectively.
CONCLUSION: Colposcopy is a better tool in diagnosing high-grade lesion
than cytology. In combination however the sensitivity in detecting HGL is
higher, but a large number of lesions were missed (25.8o/o). The study also
confirms the diagnostic value of colposcopy in management of abnormal
cervical cytology. All women with moderate and severe dyskaryosis should be
investigated colposcopically and histologically. Those with persistent
inflammatory changes or persistent low-grade dysplasia more than 6 months
should also be referred for colposcopic. The incidence of high-grade
squamous intraepithelial lesions is higher in patients with multiple sexual
partners. It is also high in patients who have spouses with multiple sexual
partners.
Description
Keywords
Cytology and colposcopy