Compliance to Standards of Colposcopy in an Effort to Reduce the Cervical Cancer Burden: An Audit

Colposcopy remains the gold standard as a triage tool for evaluating pre-invasive cervical lesions. A colposcopy scoring system is introduced to minimize inter-observer variation. The National Health Service Cervical Screening Programme (NHSCSP), in collaboration with the British Society for Colposcopy and Cervical Pathology, has published guidelines covering various issues regarding quality assurance in cervical cancer prevention, including the standard requirements for colposcopy services. Our study aimed to assess the colposcopic quality standards and evaluate the concordance of colposcopic findings with cervical biopsy in a tertiary care institution.

Retrospective data are collected from electronic medical records and colposcopy registers over a period of 5 years (1st January 2018 - 31st December 2022). According to the NHS Cervical Screening Programme Colposcopy and Programme Guidelines 2016, Parameters were recorded. Results were analyzed using SPSS version 21.

During the period of 5 years, 437 patients were identified. The mean age was 48.2±11 years. Cytology results were available in 431 (98.6%) women. The main indication of colposcopy was abnormal cervical cytology in 74.1% of patients. High-grade squamous intraepithelial lesion (HSIL) was seen in 20.4% of patients, and atypical squamous cells of unknown significance (ASCUS) in 21.3% of which 56.4% were human papillomavirus (HPV) positive.The colposcopic impression, type of transformation zone (TZ), and Swedes score were documented in 96.6%, 71.1%, and 96.3% cases, respectively. Biopsy was done in 388 (88.7%) patients (cervical intraepithelial neoplasia (CIN I) in 11.4%, CIN II-III in 26.6%, carcinoma in situ in 2.3%, and invasive cancer in 6.9%. The positive predictive value (PPV) of the Swedes' score in predicting lesions CIN2 or more was 64.5%. The correlation of the Swede's score <6 to low-grade biopsies (< CIN II) and score >6 to higher grade biopsies was fair, with a kappa coefficient of 0.3.

The subjective nature of colposcopy demands continued audit of individual practice to improve on areas found to be deficient. By using a standardized template for documentation and conducting regular audits, we can identify areas for improvement, better detection of pre-cancer lesions on colposcopy, and engage in continuous professional development.