Rakhshinda Bajwa ( Department of Pathology, Postgraduate Medical Institute, Lahore. )
Saeed Akhtar Khan ( Department of Pathology, Postgraduate Medical Institute, Lahore. )
Ghulam Rasool Qureshi ( Department of Pathology, Postgraduate Medical Institute, Lahore. )
Naseer Ahmad Chaudhry ( Department of Pathology, Postgraduate Medical Institute, Lahore. )
Colposcopic diagnosis of 156 different lesions of the cervix was compared with histologic examination of the cervical punch biopsies. Colposcopy showed high degree of sensitivity and specificity (96% and 99.2%) in cases of carcinoma of the cervix. In cervical intraepithelial neopiasia (CIN) It showed a sensitivity of 82.8% and specificity of 49.6%, while in subclinical papliloma virus Infection (SPI), it showed high degree of specificity (93.7%) but poor sensItivity (19.7%) (JPMA 43:257, 1993).
Screening programmes for detection of carcinoma of the cervix in its preclinical stage require consideration of easily identifiable variables like marital status, parity, contraceptive use, symptoms1 and risk factors like sexual habits and number of sexual partners2. In addition to cervical cytelogy, colposcopic examination has become an important part of such a screening programme3. Appropriate biopsies can be obtained through colposcope which picks up acetowhite epithelium and abnormal vascular patterns4. The present study was aimed to find out the extent to which colposcope helps in diagnosing carcinoma of, the cervix and its precursor lesions.
Patients and Methods
A total of 163 women reporting to out-patient department of Lady Wilingdon Hospital, Lahore were examined colposcopically before and after application of 5% acetic acid. The cervix, squamocolumnar junction and vaginal fomices were examined. Colposcopic diagnosis of the lesions was made on the criteria already described4-6. Colposcope directed punch biopsies were obtained from the relevant areas. The specimens were fixed in 10% formalin, embedded in paraffin and stained with. H&E and PAS. Human papilloma viral antigens were detected by immuno- histochemical staining using peroxidase-antiperoxidase technique7. After excluding inadequate biopsies (7 cases), the lesions were diagnosed as normal, chronic cervicites, subclinical papilloma virus infection (SPI), SPI+CIN, CIN and invasive carcinoma.
Recently there has been increased documentation of carcinoma of cervix and its precursor lesions alongwith human papilloma virus (HPV) infection2,6,8-10. Typical exophytic condylomata acuminata account for only a few of the infections of the cervix11. The most common manifestation of HPV Infection of the cervix is a’ macroscopically invisible lesion termed flat condyloma by Meisels and Fortin12 and subclinical papilloma virus infection (SPI) by Reid et al5. Coexisting lesions like SPI + CIN have been reported8,13-15 making the diagnosis further difficult. More or less objective criteria have been defined to diagnose all such lesions on colposcopic examination4,5. However, a number of studies6,10,16 show that colposcopic diagnosis is not accurate enough and Kirkup et al concluded that differential diagnosis of subdinical papilloma virus infection and CIN was not clear cut. In this study we found that colposcopic examination showed a high degree of specificity and sensitivity in the diagnosis of carcinoma of the cervix but not, with premalignant lesions. In cases of cervical intraepithelial neoplasia it showed quite a good sensitivity but was not specific enough to be relied upon. In the diagnosis of subclinical papilloma virus infection it was, highly specific but showed poor sensitivity. It is hoped that with further experience we will be able to improve colposcopic diagnosis in premalignant cervical lesions. Till such time, the ultimate tool to diagnose pre-malignant lesions remains the histological examination of colposcopically directed punch biopsies.
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