Correlations between Reid Colposcopic Index Impression and Cervical Histopathology

Abstract

Cancer of the uterine cervix is the second most frequent invasive cancer and the major cause of cancer death in women worldwide (Bekkers et al., 2008). Cervical cancer precursors that are diagnosed by colposcopy can be eradicated to reduce the risk of cervical cancer (Mousavi et al., 2007). Colposcopy is a diagnostic procedure used for assessing the lower genital tract and vulva under illumination and magnification. It was introduced as a technique in 1925 by Hinselmann. The primary aim of colposcopy is diagnostic validation of premalignant disease of the cervix, usually after an abnormal cervical cytology or a clinically suspicious lower genital tract (Nazeer and Shafi, 2011). Colposcopy allows the examiner to identify specific colposcopic features that distinguish normal from abnormal tissue and to form an impression as to whether the tissue is benign, preinvasive, or invasive disease. The primary goal of the colposcopist is to ensure that invasive disease is not missed (Wright and Masssad, 2002). Colposcopic features suggestive of invasive cancer include: irregular surface, erosion, or ulceration, dense  86 acetowhite change, wide irregular punctation and mosaic and atypical vessels (Schiffman and Solomon, 2003). If the colposcopic examination is performed according to acceptable protocols and guided by a colposcopic assessment method, it would allow accurate diagnosis (Reid, 1987). The purpose of a colposcopic assessment is to assist in selecting the most abnormal area for biopsy (Mousavi et al., 2007). The RCI is one of the colposcopic grading systems for assessment of preinvasive disease (Reid and Scalzi, 1985; Ferris and Greenberg, 1994). It considers four colposcopic signs: margin, color, vessels, and iodine staining. Each sign is assigned a score between 0 and 2 reflecting variation in colposcopic appearances. Scores of 0 represent normal variant (immature metaplasia). Scores of 2 represent features suggestive of CIN 3, with a score of 1 suggesting intermediate grade pathology. When the four scores are summed, total scores ranging from 0 to 2 indicate immature metaplasia or CIN 1, scores of 3–5 indicate CIN 1 to CIN 2, and scores of 6–8 represent CIN 3 (Shojaei et al., 2013). The aim of this study is to assess the accuracy of RCI for grading of colposcopic finding or diagnosis, in Ain Shams university maternity hospital.  87 This study is a cross-over study which was conducted in the Early Cancer Detection Unit (ECDU), at Ain Shams University maternity hospital. The study included 45 women were referred to Early Cancer Detection Unit with an indication for a colposcopic examination during the period between September 2014 and February 2015.