Princess Maha Chakri Sirindhorn Medical Center Nopporn Rodpenpear - PowerPoint PPT Presentation

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

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

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.

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

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.

Materials and Methods  During the period of June 2013 – May 2014. Abnormal PAP smear at least ASC-US patients after inform consent ➢ Satisfactory colposcopy ➢ Cervical cancer after ➢ Visible lesion under Inclusion Exclusion being followed up. colposcopy criteria criteria ➢ Abnormal PAP smear in ➢ Abnormal PAP smear pregnancy patients who visit OPD at MSMC Colposcopic exam Colposcopic grading by Modified RCI

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.)

Modified Reid Colposcopic index 0 points 1 points 2 points Margin Color

Modified Reid Colposcopic index 1 points 0 points 2 points Vessel - 0 to 2 : low grade : HPV infection or CIN1 - 3 to 5 : Intermediate grade : CIN2 - 6 to 8 : High grade : CIN3 Location

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

Result

Result Abnormal PAP smear at least ASC-US patients after inform consent ➢ Satisfactory colposcopy ➢ Visible lesion under Inclusion Exclusion ➢ two had cervical cancer colposcoy criteria criteria after being followed up. ➢ Abnormal PAP smear 63 patients 3 patients ➢ one was pregnant patients who visit OPD at MSMC Colposcopic exam 60 patients Colposcopic grading by Modified RCI

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) 4 (6.6) Postpartum patients Menopausal patients 6 (10.0)

Table 2 Modified Reid Colposcopic Index and Pathology Modified RCI Histopathology Total CIN I CIN II At least CIN III n (%) n (%) n (%) Low grade 24 (92.3) 2 (7.7) 0 (0.0) 26 Intermediate 10 (50.0) 6 (30.0) 4 (20.0) 20 grade 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

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 76.7% (after adjusted)

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 overall accuracy after adjusting data was 76.7%  Modified RCI is appropriated to differentiate low grade lesion from high grade lesion.

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

Discussion  Different result in Hong study.  Different race of patients.  Small sample size in high grade lesion.

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.

Thank you for your attention

Implication  A reproducible technique.  Appropriate to learn in colposcopic clinic at HRH Princess MAHA Chakri Sirindhorn medical center.

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 .

Future study  RCT study to identify discrepancies between the use of the modified RCI and not use it with histopathology.

Why do not doing LEEP in this study?  Attend only colposcopic directed biopsy.  More long term complication, if do LEEP in every patients.

Standardized to use modified RCI  Three sample patients.  One gynecologic oncologist teach to used in team.  Result from colposopic directed biopsy from each colposcopist.

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.

Table 3 Validity and Efficacy of modifield Reid Colposcopic Index Modifield RCI Histopathology Total Low grade(CIN1) High n (percentage) 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: X 2 = 19.95, P-value 0.0001, Overall accuracy 76.7 %