THE VALUE OF COLPOSCOPY IN SCREENING CERVICAL-CARCINOMA

The value of colposcopy and cytology in screening CIN was analyzed in a retrospective study of 1,504 patients treated at the Department of G ynecologic Oncology, National Institute of Oncology, Budapest from 198 0 to 1991. The majority (1,451) of the patients were admitted for hist ological confirmation of atypical colposcopic and/or cytologic finding s, and 53 women were treated for cervical repair. All women underwent either cervical excision or conization. Cytologic and colposcopic find ings were compared with the histological results. Sensitivity and spec ificity rates of cytology were 47% and 77%, respectively. The correspo nding figures for colposcopy were 87% and 15%, and for cytology and co lposcopy together, 96% and 14%. The low sensitivity of cytology sugges ts that as many as 50% of CIN lesions may be overlooked if cytology al one is used for screening, i.e. in 50% of CIN associated with abnormal colposcopy the cytology was negative. We found 194 asymptomatic patie nts with carcinoma in situ, 40 with microinvasive and 8 with frank inv asive carcinoma. This finding emphasizes the importance of cervical ca ncer screening. Our data suggest that, with colposcopy as a screening tool, the rate of false-negative cytology can be significantly reduced . Clinical implications of the ''cytology-negative abnormal colposcopy and cytology-negative CIN'' have yet to be determined. The major draw back of primary colposcopy is its low specificity with the consequence of high false-positive rate and over-treatment in a substantial numbe r of cases. To overcome the problem of low specificity, further studie s are required to identify those atypical colposcopic changes that mos t likely represent CIN- and high-grade CIN in particular.