SLIDE 1
Prospective evaluation of correlation between Modified Reid Colposcopic Index and histopathology result from Colposcopic directed biopsy in HRH Princess Maha Chakri Sirindhorn Medical Center
Nopporn Rodpenpear MD. Department of Obstetrics & Gynecology, Faculty of Medicine Srinakarinwirot University
SLIDE 2 Introduction
Colposcopy is currently used as an adjunct
intervention to enhance diagnostic capability in women with an abnormal cervical cytology test.
Reid Colposcopic Index (RCI) is a systematic
colposcopic evaluation.
More comparatively used and 97% of accuracy.
Reid R, Scalzi P . Am J Obstet Gynecol1985
SLIDE 3
Introduction
At HRH Princess Maha Chakri Sirindhorn medical
center(MSMC), Lugol’s iodine solution has not been used in the colposcopic exam.
Symptom of vaginal irritation. Either low grade or high grade lesion is not stained by
iodine.
SLIDE 4 Introduction
Hong DG, et al. report modified RCI, non-iodine use,
accuracy to detect high grade lesion was 93.6% but did not study the correlation.
Therefore, we would like to evaluate the correlation.
Hong DG, Seong WJ, Kim SY , Lee YS, Cho YL .Int. J. Clin. Oncol. 2010
SLIDE 5
Objective
To evaluate the correlation between Modified
Reid’s Colposcopic Index and histopathologic result from colposcopically directed biopsy in HRH Princess Maha Chakri Sirindhorn Medical Center.
SLIDE 6 Materials and Methods
During the period of June 2013 – May 2014.
Abnormal PAP smear at least ASC-US patients after inform consent
Inclusion criteria Exclusion criteria Colposcopic exam Colposcopic grading by Modified RCI ➢ Cervical cancer after being followed up. ➢ Abnormal PAP smear in pregnancy ➢ Satisfactory colposcopy ➢ Visible lesion under colposcopy ➢ Abnormal PAP smear patients who visit OPD at MSMC
SLIDE 7
Materials and Methods
At colposcopic exam, all cervical lesion was scored
after applying 3% acetic acid for 2 minutes by modified RCI.
Colposcopic directed biopsy on all lesions All colposcopists were standardized to use modified
RCI.(two gynaecological oncologist and a gynaecological resident under supervision.)
SLIDE 8 Modified Reid Colposcopic index
0 points 1 points 2 points Margin Color
SLIDE 9 Modified Reid Colposcopic index
0 points 1 points 2 points Vessel Location
: HPV infection or CIN1
- 3 to 5 : Intermediate grade
: CIN2
: CIN3
SLIDE 10 Statistic methods
Spearman rank correlation Accuracy Power > 90%, Significant P value < 0.05 Sample size estimation was calculated from
Boonlikit S. r= 0.66 (at least 33 patients)
Boonlikit S. J Med Assoc Thai. 2011
SLIDE 11
Result
SLIDE 12 Result
Abnormal PAP smear at least ASC-US patients after inform consent
Inclusion criteria 63 patients Exclusion criteria 3 patients Colposcopic exam 60 patients Colposcopic grading by Modified RCI ➢ two had cervical cancer after being followed up. ➢ one was pregnant ➢ Satisfactory colposcopy ➢ Visible lesion under colposcoy ➢ Abnormal PAP smear patients who visit OPD at MSMC
SLIDE 13 Table 1 Characteristic of the patients
Parameter Case ( % )
PAP smear
ASC-US 13 (21.6) ASC-H 10 (16.6) LSIL 17 (28.3) HSIL 15 (25.0) Squamous cell carcinoma 1 (1.7) AGC-NOS 1 (1.7) AGC-FN 1 (1.7) AIS 1 (1.7) Adenocarcinoma 1 (1.7)
Postpartum patients
4 (6.6)
Menopausal patients
6 (10.0)
SLIDE 14 Table 2 Modified Reid Colposcopic Index and Pathology
Modified RCI Histopathology Total CIN I n (%) CIN II n (%) At least CIN III n (%) Low grade 24 (92.3) 2 (7.7) (0.0) 26 Intermediate grade 10 (50.0) 6 (30.0) 4 (20.0) 20 High grade 2 (14.3) 1 (7.1) 11 (78.6) 14 Total 36 (60) 9 (15) 15 (25) 60
Spearman’s rank correlation is 0.69, P value = 0.0001
SLIDE 15
Table 3 Accuracy of modified Reid Colposcopic Index
Modified RCI Accuracy CIN I 92.3 % CIN II 30.0 % CIN III 78.6 % Low grade lesion 92.3 % High grade lesion (CIN2,3) 64.7 % Overall Modified RCI (after adjusted) 76.7%
SLIDE 16 Discussion
In our study, modified RCI had a good correlation
with the histopathology (r=0.69 using Spearman’s rank correlation, p = 0.0001)
Accuracy to detect low grade lesion was 92.3% and
- verall accuracy after adjusting data was 76.7%
Modified RCI is appropriated to differentiate low
grade lesion from high grade lesion.
SLIDE 17 Discussion
Hong DG, et al=> use Modified RCI, report high
accuracy to detecting high grade lesion (93.6%)
We found good strength of correlation and high
accuracy to detect low grade lesion.
But, not high as Hong in high grade lesion.
Hong DG, Seong WJ, Kim SY , Lee YS, Cho YL. Int. J. Clin. Oncol. 2010
SLIDE 18
Different result in Hong study. Different race of patients. Small sample size in high grade lesion.
Discussion
SLIDE 19
Conclusion
Modified Reid’s Colposcopic Index has a good
positive correlation with cervical histopathology and also has high accuracy to differentiate low grade lesion from high grade lesion.
SLIDE 20
Thank you for your attention
SLIDE 21
Implication
A reproducible technique. Appropriate to learn in colposcopic clinic at HRH
Princess MAHA Chakri Sirindhorn medical center.
SLIDE 22 Limitations of our study
1) The colposcopists know the severity of abnormal PAP
smear of each patient.
2) If no lesion was found under the colposcopic
examination, we did not offer scores of modified RCI of the lesion. But if cervical cytology is more than HSIL, we will consider doing LEEP .
SLIDE 23 Future study
RCT study to identify discrepancies between the use of
the modified RCI and not use it with histopathology.
SLIDE 24
Why do not doing LEEP in this study?
Attend only colposcopic directed biopsy. More long term complication, if do LEEP in every
patients.
SLIDE 25
Standardized to use modified RCI
Three sample patients. One gynecologic oncologist teach to used in team. Result from colposopic directed biopsy from each
colposcopist.
SLIDE 26 Sample size
Assign : = 0.05, Z = 1.96, = 0.01, Z = 2.326 Boonlikit S. 2011 report correlation between RCI and
Histopathology was 0.66
Boonlikit S. Correlation between Reid’s colposcopic index and histologic results from colposcopically directed biopsy in differentiating high-grade from low-grade squamous intraepithelial lesion at Rajavithi Hospital. J Med Assoc Thai. 2011 Mar;94Suppl 2:S59-65.
SLIDE 27 Table 3 Validity and Efficacy of modifield Reid Colposcopic Index
Modifield RCI Histopathology Total Low grade(CIN1) n (percentage) High grade(CIN2,3) n (percentage) Low grade 24(92.3) 2(7.7) 26 High grade 12(35.3) 22(64.7) 34 Total 36(60) 24(40) 60
Sensitivity 91.7%, Specificity 66.7% Positive predictive value 64.7 %, Negative predictive value 92.3 % Chi-square test: X2= 19.95, P-value 0.0001, Overall accuracy 76.7 %
