Role of cytology, colposcopy and colposcopic directed biopsy in the evaluation of unhealthy cervix

Alpana Agrawal, Amita Sharma, Manisha Gupta, Neelima Agarwal


Background: The objective was to find out the magnitude of precancerous lesions and evaluate the performance of colposcopy in estimating the presence and grade of cervical disease vs conventional Pap smear testing of women with unhealthy cervix.

Methods: This was a prospective observational study. All the women were subjected to Pap smear and colposcopy, whereas histopathology was done in patients having abnormal findings on colposcopy. Biopsies were taken from the abnormal areas.

Results: Out of 110 women who completed the study 60 (54.5%) had changes in their cervical epithelium on colposcopy. These 60 women with unhealthy cervix underwent cervical biopsy, and 20 (33.3%) had histologically proven chronic cervicitis, 6 (10%) had chronic cervicitis with condylomatous change followed by 17 (28.3%) with CIN 1 lesion, 8 (13.3%) with CIN 2, 4 (6.7%) with CIN 3 lesion and only one (1.7%) had histologically proven malignancy. Cytology alone identified the population at risk with a high sensitivity [70.00% (95% CI: 50.60 % to 85.24 %)] but low specificity [60.00% (95% CI: 40.61 % to 77.32 %)] rate. Colposcopy showed a high sensitivity rate [93.33 % (95% CI: 77.19 % to 98.99 %)] but a limited specificity [70.00% (95% CI: 50.60% to 85.24%)].

Conclusions: It is very important to diagnose the CIN lesions with accuracy once a woman comes to a tertiary care hospital with symptoms or is referred for a suspicious looking cervix. All these women must be screened by colposcopy and directed biopsy must be taken if indicated in the same sitting.


Colposcopy, Pap smear, Premalignant lesion of cervix, Suspicious looking cervix

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