Direct Colposcopy versus Colposcopy in Screen-positive Women for Detection of Precancerous and Cancerous Lesions of the Cervix

Aim: The aim of the study was to assess the role of direct colposcopy in screening precancerous and cancerous lesions of the cervix. Methodology: This descriptive-analytical study was carried out between October 2019 and March 2021 (18 months), after obtaining ethics committee approval. An opportunistic screening was done in the outpatient department. Screen-positive women either by visual inspection with acetic acid/Lugol’s iodine/Pap smear/human papillomavirus DNA were subjected to colposcopy. Direct colposcopy was done in women having unhealthy-looking cervix. A total of 92 colposcopies were done, out of which 46 were done in screen-positive women (Group 1) and 46 were direct colposcopies for unhealthy-looking cervix (Group 2). Women with positive findings on colposcopy were subjected to directed cervical biopsies, while in others random biopsy was taken. Pregnant women, women having active vaginal bleeding, or any past treatment for cervical lesions were excluded from the study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of colposcopy were calculated in both groups. Results: The mean age of subjects was 43.76 ± 13.02 years, and 48.9% of women had parity ≥3. Demographic data such as median age, mean parity, lower socioeconomic status, age <18 years at first sexual contact, first childbirth at age <18 years, addictions (smoking/tobacco), and contraceptive use were comparable in both groups. Colposcopy was adequate in all women. Swede score ≥5 on colposcopy was noted in 37% of patients in Group 1, while in 60.9% of patients in Group 2. In Group 1, cervical biopsy showed benign pathology in 30, CIN 1 in 4, CIN 2/3 in 9, and malignancy in 3 women. In Group 2, it was benign in 15, CIN 1 in 14, CIN 2/3 in 12, and malignancy in 5 women. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of colposcopy was 87.5%, 63.3%, 56%, 90.5%, and 71.7% in Group 1 and 93.5%, 40%, 76.3%, 75%, and 76.1% in Group 2, respectively. Conclusion: Direct colposcopy is a useful method to detect precancerous and cancerous lesions of the cervix.