1. The Accuracy of Diagnostic Colposcopy Using ISCCP 2011 Classification
SUJOY DASGUPTA,
Senior Resident,
Department of Gynecological Oncology,
Chittaranjan National Cancer Institute(CNCI), Kolkata

2. International Federation of Cervical Pathology & Colposcopy 2011
General Assessment
Adequate/ inadequate for the reason
Squamo-columnar Junction visibility
Transformation zone types 1,2,3
Normal Colposcopic Findings
Original squamous epithelium:
Columnar epithelium
Metaplastic squamous epithelium
Deciduosis in pregnancy
Abnormal findings
General Principles
Location of the lesion:
Size of the lesion:
Grade 1 (Minor)
Thin aceto-white epithelium
Fine mosaic, Fine punctation
Grade 2 (Major)
Dense aceto-white epithelium, Rapid acetowhitening
Coarse mosaic, Coarse punctuation
Nonspecific
Leukoplakia, Erosion, Lugol’s staining
Suspicious for invasion
Atypical vessels; Additional signs
Miscellaneous findings
CTZ, Condyloma, Polyp, Inflammation
Stenosis, Congenital anomaly, Post treatment, Endometriosis

3. To determine the ability of the colposcopists to correctly identify the various categories of cervical neoplasia using IFCPC, 2011 terminology
To determine the accurarcy of coposcopy in non-cytology based screening programme

4. Approved by CNCI Human Research Ethics Committee
STUDY DESIGN
Prospective Study
STUDY POPULATION
Subjects participating in a community-based cervical cancer screening demonstration project
Approved by CNCI Human Research Ethics Committee

5. Inclusion Criteria
Non-pregnant women
Age years
Intact uterus
Without past history of cervical precancer/ cancer

6. Cervical specimen collection
STUDY METHODOLOGY
Written Informed Consent from all the participants
Examination by trained health workers
Cervical specimen collection
for Hybrid Capture 2 (HC2)
(HPV DNA of 13 high-risk types)
VIA (Visual Inspection with Acetic Acid)

7. STUDY METHODOLOGY (Contd.)
VIA Positive
women
HC2 positive
women
(not having colposcopy in the field)
Every 10th
VIA negative
Woman
Colposcopy
in the
same sitting
Recalled for
colposcopy
Colposcopy
in the
same sitting
IFCPC 2011 terminology for documentation

8. STUDY METHODOLOGY (Contd.)
Punch Biopsies
In case of colposcopic findings of
- Grade 1 or worse abnormalities
- Miscellaneous findings
From the worst affected areas - close to the squamo-columnar junction (SCJ)
Multiple biopsies- if the lesion extends to >2 quadrants
For HC2 +ve women with NORMAL colposcopy
- punch biopsy taken from anterior lip

9. STUDY METHODOLOGY (Contd.)
Colposcopic impressions were compared with
the histological diagnosis as gold standard
Histology
Colposcopy
Grade 1
Grade 2
Invasive
L-SIL
Perfect agreement
H-SIL
Strength of agreement was measured
using the weighted kappa statistics

10. DEMOGRAPHIC VARIABLES of Screened Women (n = 30773)
Mean age (years)
Mean age at marriage (years)
Median number of pregnancies
Menopausal status
Pre-menopausal %
Post-menopausal %

11. SELECTION OF STUDY CASES
Total women screened
30773
Colposcopy done
Screen positive
3178
5556
Screen negative
2378
Biopsy done
2511
Inconclusive biopsy 45
Both colposcopy and satisfactory biopsy report
FINAL ANALYSIS
2466

12. Agreement in classifying cervical biopsy sample
Exact agreement between colposcopy and histology- 40.3% (993/2466)
* Weighted kappa <0.6 - poor agreement
>0.6 - good agreement
1.0 - excellent agreement
Agreement in classifying cervical biopsy sample
Weighted kappa*
Impression
Overall (n= 2466)
0.17
Poor
VIA +ve (n = 1763)
0.12
HC2 +ve (n = 620)
0.35
'Fair'

13. AGRREEMENT (Contd.) Histo Diagnosis
Colpo Diag
Histo Diagnosis
Normal
Misc
L-SIL
H-SIL
Inv
Total
175 (35.8%)
130
157 25 1
488 22
25 (32.4%) 24 5 77
Grade 1
420
403
688 (43.3%) 72 4
1587
Grade 2 35 41
108
75 (28%) 8
267 2 3 7
30 (63.8%) 47
654
602
982
184 44
2466

14. TEST PERFORMANCE OF COLPOSCOPY In Detecting H-SIL or Worse Lesions
Adjusting for verification bias (IFCPC grade 1 as the threshold for referral)
Performance of Colposcopy
Sensitivity
Specificity
Positive Predictive Value (PPV)
Negative Predictive Value (NPV)
Overall
84.8%
66.1%
10.3%
98.9%
VIA +ve women
94.6%
23%
8.7%
98.2%
HC2 +ve women
78.8%
76.7%
39.4%
94.9%

15. DISCUSSION

16. Advantages of those studies-
Almost all the earlier studies - conducted in colposcopy clinics where women were referred for abnormal cytology (Pap smear)
Advantages of those studies-
Prior knowledge of cytological abnormalities can influence colposcopic diagnosis
Cytology is more specific than VIA and HC2, so less chance of False Positive Colposcopy & Histology

17. SALIENT FINDINGS
Observed sensitivity to detect H-SIL+ is ≈90%, comparable to the that found in a meta-analysis of 8 longitudinal studies (60-97%)
Colposcopy overestimates the severity of premalignant lesions, as seen in other studies
Performs better in differentiating high grade from low grade lesions, rather than in differentiating low grade lesions from normal
25 HSIL cases did not have any colposcopic abnormality – suggesting ‘THIN CIN’

18. Accuracy of colposcopy is acceptable in non-cytology based screening using the IFCPC 2011 terminology

19. THANK YOU

20. ACKNOWLEDGEMENT Dr Partha Basu Dr Ranajit Mandal Dr Pradip Das
Dr Dipanwita Banerjee
Dr Priyanka Singh
All the health workers of CPCI Project, CNCI