Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesion : a four - year experience in Hospital University Sains Malaysia
| dc.contributor.author | Mohamed Tarmizi, Mohamed Hatta | |
| dc.date.accessioned | 2017-08-18T01:37:32Z | |
| dc.date.available | 2017-08-18T01:37:32Z | |
| dc.date.issued | 2001-11 | |
| dc.description.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. | en_US |
| dc.identifier.uri | http://hdl.handle.net/123456789/4383 | |
| dc.language.iso | en | en_US |
| dc.publisher | Universiti Sains Malaysia | en_US |
| dc.subject | Cytology and colposcopy | en_US |
| dc.title | Diagnostic accuracy of cytology and colposcopy in cervical squamous intraepithelial lesion : a four - year experience in Hospital University Sains Malaysia | en_US |
| dc.type | Thesis | en_US |
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