Abnormal colposcopic images in patients with pre-invasive cervical lesions

© 2013 Adnan Baboviæ et al.; licensee University of Sarajevo Faculty of Health Studies. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. UNIVERSITY OF SARAJEVO FACULTY OF HEALTH STUDIES ABSTRACT


INTRODUCTION
Organized screening programs protect against cervical cancer by identifying women with abnormal cytological fi ndings for further review by colposcopy and cervical biopsy, and possibly surgical removal of histological verifi ed cervical intraepithelial neoplasia (CIN), a higher grade, as a precursor of cervical cancer (1).Cervical intraepithelial neoplasia (CIN), are the changes limited to the epithelium, which means that there is no invasion of the stroma, basal membrane is preserved, and there is a lack of infi ltration (2,3).Th anks to the simplicity and reliability of the Pap test screening cervical cancer can be detected in the preclinical stage of CIN / SIL (cervical / squamous intraepithelial neoplasia), when a cure is possible by locally destructive or excision methods.In most EU countries, cytological screening begins at the age of 20 and 25 years, and exceptionally 15 or 30 years, and the interval between two cytological analyses, in the case of regular fi ndings, is usually 3 years, rarely 1 or 5 years (4).Colposcopy is easy to perform diagnostic method that is not followed by any complications and provides plenty of elements for triage diagnosis of abnormal cytological smears during routine gynecological examinations of vulnerable female population (5).
Th is method provides a reliable estimate of the localization and extent of the pathological epithelial lesions, and the possible target biopsy of the suspected area.Th e accuracy of this method lies between 60-85%, and in combination with cytology 98-99%.Th e incidence of false-positive fi ndings is estimated at 7% and a false-negative diagnosis in 13%.Colposcopy is, therefore, an excellent diagnostic complement to cytology (6).Th e aim was to determine the frequency and compare the frequency of abnormal colposcopy images in patients with low and high grade pre-invasive cervical lesions.

METHODS
In this retrospective-prospective study 259 patients were analyzed in 2007 and 2011.All the patients underwent colposcopy and cervical cytology examinations.Th e experimental group consisted of (N=113) patients with pre-invasive cervical lesions classifi ed by Bethesda classifi cation, while the control group consisted of the patients with the same demographic characteristics but with cytological fi ndings with no signs of intraepithelial lesion (N=146).Colposcopic images were analyzed in both groups, and obtained colposcopic fi ndings were duly recorded.Experimental group with preinvasive lesions was divided into two sub-groups (N=51) with low-grade squamous intraepithelial lesions (LG-SIL), and (N=62), patients with high-grade squamous intraepithelial lesions (HG SIL).Th e patients with unsatisfactory cytological and colposcopic fi ndings, as well as those patients having fi ndings indicating an invasive carcinoma were excluded from the study.
Statistical analysis was performed by application software Statistical Package for Social Sciences for Windows, version 18.0 PASW-SPSS Inc., Chicago, IL, USA.Categorical variables will be presented as frequencies and percentages.Continuous variables will be presented as mean with standard deviation or medians with interquartile ranges, depending on the distribution of data.Normality of distribution and homogeneity of variance was checked by adequate tests.Testing for diff erences in the distribution of cruciate qualitative variables (independent distribution) will be expressed by chi square test.Level of signifi cance 'p <0.05 was employed.

DISCUSSION
Th ere were unsatisfactory colposcopic fi ndings n=22 (8.5%), in 75% of cases it was the age group >= 45 years (N = 16), which is consistent with the works of other authors (7) Our study cannot assess the diagnostic accuracy of cytology and colposcopy, because it is lacking histological confi rmation of the lesion, as it is conducted in a study that examined the diagnostic accuracy of cytology, colposcopy and biopsy on 151 patients, when it was concluded that correct evaluation of severity of lesion requires a combination of diagnostic methods (11).

CONCLUSION
Th anks to characteristic colposcopic images abnormal epithelium is successfully detected, and a colposcopy may be used in secondary screening in the control programme of cervical cancer.Only on the basis colposcopic images one cannot determine severity of intraepithelial lesion.

FIGURE 6 .
FIGURE 6.There is a signifi cant difference in the distribution of colposcopic images by cytological fi ndings.Most abnormal colposcopy fi ndings are in category of cytological fi ndings HSIL and LSIL (Pearson Chi-Square, 97.98, df-3, (p<000.1),Kendalls tau 0.54).

FIGURE 7 .FIGURE 8 .
FIGURE 7. Citlogical fi nding.Abnormal colposcopic image The age distribution histogram.The age distribution histogram shows the normal age distribution in the sample with Mean -43.27 and SD-10.16.The youngest analyzed patient was 21 years old and the oldest 78 years.