DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182053

Evaluation of women with postcoital bleeding by clinical examination, papsmear, colposcopy and histopathology of cervix

Srilakshmi Yarlagadda, Rangarao Diddi, Prasuna J. L. Narra

Abstract


Background: Postcoital bleeding refers to spotting or bleeding per vagina that occurs after intercourse and is not related to menstruation. Although there are multiple benign etiologies to this complaint, the most serious cause of postcoital bleeding is cervical cancer (3-5.5%). Cervical cancer is the most common and preventable genital cancer of women. It has a long premalignant phase and with an ideal screening test with good sensitivity and specificity, we can diagnose and treat premalignant cervical lesions, preventing cervical cancer. The present study is aimed to evaluate the women with postcoital bleeding by clinical examination, pap smear, colposcopy and guided biopsy to detect premalignant cervical lesions and carcinoma cervix.

Methods: This was a prospective and retrospective study conducted from April, 2016 to March, 2018 for a period of 24 months in the Department of Obstetrics and Gynaecology on 100 women with postcoital bleeding at Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (Dr. PSIMS&RF). After clinical examination, these women were subjected to pap smear, colposcopy and guided biopsy. The findings were correlated with histopathology of cervix. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of both papsmear and colposcopy were calculated.

Results: Sensitivity of papsmear was 71.42%, specificity-86.20%, PPV-78.95%, NPV-80.64% and accuracy-80%. Sensitivity of colposcopy was 90.47%, specificity-89.65%, PPV-86.36%, NPV-92.85% and accuracy-90%.          

Conclusions: These results establish colposcopy as an effective screening test for carcinoma cervix. Histopathology of suspected cervical lesion in colposcopy remains the gold standard for definitive diagnosis.


Keywords


Cervical cancer screening, Colposcopy, Postcoital bleeding, Papsmear, Premalignant lesions of cervix

Full Text:

PDF

References


Tarney CM, Han J. Postcoital bleeding: a review on etiology, diagnosis, and management. Obstet Gynecol Int. 2014;2014.

Shapley M, Blagojevic‐Bucknall M, Jordan KP, Croft PR. The epidemiology of self‐reported intermenstrual and postcoital bleeding in the perimenopausal years. BJOG: Int J Obstet and Gynaecol. 2013;120:1348-55.

Tehranian A, Rezaii N, Mohit M, Eslami B, Arab M, Asgari Z. Evaluation of women presenting with postcoital bleeding by cytology and colposcopy. Int J Gynecol and Obstet. 2009;105:18-20.

Selo-Ojeme DO, Dayoub N, Patel A, Metha M. A clinico-pathological study of postcoital bleeding. Arc Gynecol Obstet. 2004;270:34-6.

Fraser IS, Petrucco OM. Management of intermenstrual and postcoital bleeding, and an appreciation of the issues arising out of the recent case of O'Shea versus Sullivan and Macquarie pathology. Aus NZ J Obstetrics Gynaecol. 1996;36:67-73.

Pardanani NS, Tischler LP, Brown WH, Feo ED. Carcinoma of cervix. Evaluation of treatment in community hospital. New York state J Medi. 1975;75:1018.

Pretorius R, Semrad N, Watring W, Fotheringham N, Presentation of cervical cancer, Gynecol Oncol. 1991;42:48-53.

Shalini R, Amita S, Neera MA. How alarming is post-coital bleeding–a cytologic, colposcopic and histopathologic evaluation. Gynecol Obstet Investi. 1998;45:205-8..

Rosenthal AN, Panoskaltsis T, Smith T, Soutter WP. The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding. BJOG: Int J Obstet Gynaecol. 2001;108:103-6.

Jha S, Sabharwal S. Outcome of colposcopy in women presenting with postcoital bleeding and negative or no cytology-results of a 1-year audit. J Obstet Gynaecol. 2002;22:299-301.

Anorlu RI, Abdul-Kareem FB, Abudu OO, Oyekan TO. Cervical cytology in an urban population in Lagos, Nigeria. J Obstet Gynaecol. 2003;23:285-8.

Kurman RJ. Tumors of the cervix, vagina, and vulva. Atlas Tumor Pathol. 1992;4:55-61.

Viikki M, Pukkala E, Hakama M. Bleeding symptoms and subsequent risk of gynecological and other cancers. Acta Obstet Gynecol Scandina. 1998;77:564-9.

deSouza NM, Gilderdale DJ, Soutter WP, McIndoe GA, Krausz T. Stage I cervical cancer: tumor volume by magnetic resonance imaging of screen-detected versus symptomatic lesions. J Nat Cancer Insti. 1997;89:1314-5.

Zeligs KP, Byrd K, Tarney CM, Howard RS, Sims BD, Hamilton CA, Stany MP. A clinicopathologic study of vaginal intraepithelial neoplasia. Obstet and Gynecol. 2013;122:1223-30.

Gangwal H, Rajoria L. Evaluation of Postcoital Bleeding by Clinical And Pathological Finding. IOSR J Dent Med Sci. 2015;14:31-4.

Gupta M, Sharma A, Agarwal N, Agarwal A. Clinical profile of women with postcoital bleeding. Univer J Health Sci. 2016;2:106-8.

Shapley M, Jordan J. A systematic review of postcoital bleeding and risk of cervical cancer. Br J Gen Pract. 2006;56:453-60.

Abdelkrim M, Abedelnacer T, Abdelkrim S. Frequency Of Significant Cervical Pathology In Women Attending A Teaching Gynaecological Service For Postcoital Bleeding With Normal Cytology. Int J Gynecol Canc 2016;26:28-9.