Colposcopy of patients with cytologic inflammatory epithelial changes

Area of Science:

• Gynecology
• Pathology
• Oncology

Background:

• Cervical cytology screening is crucial for early detection of cervical abnormalities.
• Inflammatory epithelial changes (IECs) on cervical cytology can obscure underlying significant pathology.
• The diagnostic yield of colposcopy following an IEC diagnosis requires further investigation.

Purpose of the Study:

• To evaluate the utility of colposcopy in detecting cervical intraepithelial neoplasia (CIN) and human papillomavirus (HPV) infection in women with a cytologic diagnosis of IEC.
• To determine the prevalence of HPV or CIN among women with IEC who undergo colposcopy and biopsy.

Main Methods:

• A retrospective review of 3,308 cervical cytologies performed between September 1986 and September 1987.
• Colposcopy was offered to 371 patients with IEC; 200 underwent the procedure.
• Histologic analysis of biopsies from patients with atypical transformation zones.

Main Results:

• Of 200 women with IEC who underwent colposcopy, 44 had an atypical transformation zone.
• Biopsies from 33 women revealed diagnoses including HPV infection (4 cases) and cervical intraepithelial neoplasia (CIN) (4 cases), with most showing CIN I.
• The 95% confidence interval for detecting HPV or CIN in women with IEC was 8.5% to 23.5%.

Conclusions:

• Colposcopic examination following an IEC cytologic diagnosis may identify cases of CIN that are missed by standard screening.
• The potential for colposcopy to improve detection rates for significant cervical pathology warrants consideration.
• Further studies are necessary to address potential biases from false-positive histology reports before widespread recommendation.