Analysis Of The Value Of Colposcopy In Screening Cervical Precancerous Lesions

Cervical cancer is one of the most dangerous (common) female pelvic cancer, and women who have not screened are at greater risk. Due to the development of economic condition of the country, widespread cytologic screening has had a major impact on the prevention, earlier detection and treatment. The overall incidence of cervical cancer and death rate from it, have declined recently due to aggressive screening programs. Many studies have been done in cervical cancer, and there has been progress in the diagnosis and treatment. Cervical cancer is a disease that can be prevented through both primary prevention and early detection using screening techniques.Objective:This study includes RCI Score under colposcopic examination and LPT in the screening of cervical cancer。To observe and evaluate the improved RCI and LPT examination, and search for the ideal screening method of cervical cancer for our country.Materials and Methods:This study is conducted in Jilin University, Gynecology and Obstetrics Out patient Department during a period of 4 to 7 months in 2006. In this study, LPT and RCI scoring under colposcopy examination was performed, and biopsy of abnormal cervical lesion under colposcopy was taken, and sent for histopathological examination. Age from 21 to 67 years (average 37.34 years). These examinations were performed in these women:1. Vaginal discharge (foul smelling yellowish or Blood-stained)2. Post coital bleeding3. Irregular vaginal bleedingOn the basis of histopathological report, clinical analysis was performed.Major steps during examination include:(1) Vaginal speculum was inserted to expose the cervix; cotton was used to wipe the vaginal and cervical secretion.(2) Color, boundary, blood vessel, and presence or absence of cervical erosion was noted under direct visualization. Cervical brush was gently inserted into the cervical canal, about 1cm deep, rotated for 5 times, and the specimen was immediately placed into the bottle containing fixation liquid, positive cytological examination includes ASC-US/AGUS, ASC-H, LISL, HISL.(3) Then colposcopy examination was carried out, using OLYMPUS OCS-3 TYPE COLPOSCOPE. 3% acetic acid (vinegar) solution was applied to the cervix for 1 minute with a cotton-tipped swab. After 1 minute, visual inspection of squamous epithelium, columnar epithelium, especially color, border and blood veils of squamocolumnar junction were noted. RCI score was used to evaluate the cervical status.(4) During colposcopy examination, biopsy of abnormal lesion taken, and if there is no any abnormal finding, biopsy of cervix was taken at 4 o'clock. Statistical analysis: Sensitivity=[True positive/(True positive+False positive)]×100%; Specificity=[True negative/(True negative+False negative)]×100%χ~2 test was used for evaluation.Result:1. Competitive study of sensitivity between Cytology examin- ation and colposcopy screening. Among 109 patients, 37 were as diagnosed as Cervical Intraepithelial Neoplasia (CINI-III), 12 cases of Cytological examination positive, sensitivity 32.43% (12/37), 32 cases were diagnosed under colposcopy examination, sensitivity 86.49% (32/37),χ~2shows there is significant difference in two groups (p<0.01). The sensitivity of two ways is 97.30% (36/37). Analysis of Sensitivity of Colposcopy examination combined with RCI Score reaches 86.49% (5/37), Specificity 45.83% (33/72), Missed diagnosis rate and false negative rate is 13.16% (5/37), False diagnosis and false positive rate is 54.17 (33/38). 2. We compare RCI scoring and LPT diagnosis with histopatho- logical, and each class complete coincidence are, CINI 65.20% (15/23), CINII 75% (6/8), CINIII 83.33 (5/6) and general coincidence increase according to pathological changes degree. Comparative study of combination of Cytology examination and colposcopy examination. Combining LPT examination and cytology examination have improved in the diagnosis, difference: CINI 17.39% (4/23), CINII 50% (4/8), CINIII 66.67% (4/6), but still there is lower in accuracy compared to RCI.3. There is relation between RCI Scoring and CIN. The RCI score have different influence to CIN diagnosis and the missed diagnosis of patient is low4. CIN is related with abnormal finding during colposcopy examination. Acetowhite changes on application of acetic acid are the most common finding among atypical vessel, coarse mosaics and punctuation. One or more than one abnormal findings may be present.Discussion:1. Because LPT technology conserve nearly all cell on the special tool and wipe off the interference of impurity in the specimen, improved the sensitivity and specificity by avoiding excess overlap of cell. But we can't avoid the error in taking specimen and reading level and cytology as the first step of cervical lesion"three ladder"have conservatism, so the rate of missed diagnosis is comparatively high. It has more diagnostic accordance rate than cytology that we direct observe surface of cervix to evaluate and analyze cervix comprehensively, objectively and quantifiably with improved Reid grade. In the test another cause that false negative rate is lower than literature report are that it is mutually influenced between cytology inspection and colposcopy inspection. If carried out cytology inspection in advance, the image of cervix surface will be influenced by blood after brush the cell; If carried out colposcopy inspection in advance, the quantity of cell will be reduced after operation. The current data show the sensitivity is 86.49% and negative forecast is 86.84%, it is lower than the report of Chen Jianmin etc. and the specificity is low and 45.83%. It exist false negative rate 13.16% and false 54.17% masculine rate. One of the cause is that colposcopy is belong to visualized image diagnose, and it is short of specificity. For the pathological changes in the cervical canal or surface undersize, colposcopy inspection gets definite restriction and exist limitation, so it is easy to miss diagnosis. The second cause is that CINI is same to acetic acid response of squamous metaplasia. Though RCI grade quantified description diagnose, it exist still subjective. It is nearly relative with clinical experience. Therefore colposcopy physician need strict training. 2. Many factors decided the severity degree of abnormal image in the colposcopy. Following the constant increasing of abnormal epithelial karyon, after smearing acetic acid it show white epithelia, pathological changes are bad, nucleoplasm proportion are obvious. Therefore white epithelia are bad and light pathological changes show flat and blurry, serious tend to protuberant and boundary clear. Abnormal blood vessel is mark that pathological changes constant developing. Following degree of pathological changes is bad, it will show crassitude punctuate blood vessel nested and indeed crassitude straight blood vessel. The bad degree of pathological changes is, the easier all kinds of the image in the colposcopy and more vigilant the scrutator will be. Then the veracity will be enhanced. The accordance accuracy of LPT inspection will be enhance following the pathological changes, but the comparative result show, The diagnostic accuracy of LPT inspection is lower than colposcopy RCI grade. The conservation of cytology filtration is lower following the pathological changes, and the experience of cytology diagnose is difficult to accumulate. 3. More RCI score is, more diagnostic veracity and masculine forecast are. In addition, high single score of colposcopy RCI diagnose is consanguineous with CIN and the level of colposcopy diagnose is high. The colposcopy abnormal image, such as, white epidermis, spot blood vessel, mosaic and abnormal blood vessel, is bad. As validate the rationality of RCI diagnose grade standard. 4. We can observe the occurrence rate of acetic acid white epidermis is the most, in the abnormal colposcopy image, such as, acetic acid white epidermis, crassitude spot blood vessel and mosaic, and acetic acid white epidermis can appear lonely or exist with other image. The masculine rate that two kinds or more image concurrence is more than one. Acetic acid white epidermis, crassitude spot blood vessel and mosaic call cervical pervasive cancer three united trait. 5. Colposcopy inspection exist limitation, but merits are more comparatively. It is still feasible and available method and we can reduce the limitation via inspecting seriously.Conclusion:1. LPT alone is not reliable in the diagnosis (screening) of cervical cancer. LPT combined with RCI scoring under colposcopy examination increase the sensitivity, and decrease missed diagnosis.2. The cost of unification between LPT and RCI score diagnosis is suitable, and the screening effect is increased. So fit life condition of North person.3. Colposcopy examination has a major role in the screening (diagnosis) of cervical lesion4. RCI Scoring is easy, useful, acceptable, but this examination should be performed by the expert person with special training and skills and, may increase the accuracy in diagnosis.