Srinivas Sangisapu 1 , Prajakta Mehendale 2 , Aruna Menon 3 , Venkatesan Manu
BACKGROUND Cancer cervix is the most common and preventable malignancy in females. 80% of cases in India are detected in advanced stages. Paucity of cytologists in India is one of the important reasons for failure of screening by Pap smear. Visual Inspection of cervix with Acetic acid (VIA) and Visual Inspection of cervix with application of Lugol’s Iodine (VILI) are two alternative strategies in low resource settings. Colposcopy involves the same principles of VIA and VILI under better magnification. We have hospitals with not so low resource settings, where gynaecologists are available, but cytologists are not. We need to evolve an alternative strategy appropriate to our resources such as colposcopy and guided biopsy. The aim of the present study is to evaluate the feasibility of colposcopy as an alternative screening tool for cervical precancer. The objective of the study is therefore to compare the colposcopy with the known reference standard that is Pap smear and evaluate the sensitivity, specificity and predictive values. MATERIALS AND METHODS 3000 women were compared with simultaneous colposcopy and Pap smear with latter as reference standard. Colposcopy-guided cervical biopsy was performed for suspicious lesions. RESULTS Unsatisfactory colposcopy due to nonvisualisation of transformation zone is an insignificant percentage (1.7%). The sensitivity, specificity, positive and negative predictive values of colposcopy for the threshold of normal versus all grades of abnormality (all age groups and all abnormal reports included) are 76.74%, 99.34%, 63.46% and 99.65%, respectively. Pap smear is taken as a reference standard. This is the primary objective of our study. Colposcopy-guided biopsy specimens of minor abnormal colposcopic lesions falling outside the transformation zone have not yielded any abnormal findings on histopathology. Three high-grade lesions were detected by colposcopy as well as Pap smear. They have also positively corroborated with histopathology. CONCLUSION Colposcopy has got a good negative predictive value. It seems to be as sensitive and specific as Pap smear for high-grade lesions. However, multicentric studies is recommended for pooled data.
