A Comparative Study between Colposcopy versus Histo and Cytopathology as Diagnostic Tools for Detection of the Causes of Post Contact Bleeding

Postcontact Bleeding (PCB) is defined as bleeding occurring during or immediately after cervical contact as sexual intercourse, vaginal examination and vaginal douches at a time separate from menstruation. It is a common, multifactorial, gynecological symptom.In a review of PCB, the point prevalence of PCB among women in the community ranged from 0.7% to 9%. Occasionally, it is the first presentation of precancerous cervical lesions, and the prevalence of PCB in women with cervical cancer has been reported to vary between 0.7% and 39%. Cervical cytology is used to evaluate women with PCB, and colposcopy is usually performed when there is abnormal cytology.The current management of PCB is not constant. Colposcopy is an important component of the cervical screening program, but there are several disadvantages for patients with PCB undergoing colposcopy screening; for example, patient anxiety and undue distress, use of valuable colposcopy time, and the progression to unnecessary interventions. The aim of this study was to evaluate women with PCB using clinical examination, cytology, colposcopy, and pathology in order to know the accuracy of each and all in determining the causes of bleeding. This study included fifty women with Post-Contact Bleeding (PCB). Each woman was asked about the following full history taken: complete history taking, clinical examination, cytological examination, colposcopic examination and colposcopically-guided punch biopsy. Our results showed that: Forty patients (80%) belonged to the sexually active reproductive age group, only 2 patients (4%) were below 20 years and 3 patients (6%) were postmenopausal. Postcontact bleeding was infrequently seen in nulliparas i.e. 2 patients (4%), primiparous in 4 patients (8%) and 44 patients (88%) were multiparas. All patients were non-smoker and non-alcoholic. None of the 50 patients was pregnant and all patients belonged to low socioeconomic status. All women had undergone cytological examination. Cytology identified 6 patients (12%) only with LGSIL and 3 patients (6%) with HGSIL. Colposcopy revealed atypical transformation zone in 15 patients (30%). Majority of patients i.e. 34 patients (68%) had typical transformation zone and only one patient (2%) had unsatisfactory colposcopic findings. Vascular ectopy was detected in 15 patients (30%). Colposcopically directed biopsies were obtained in total of 16 patients (32%) of all patients who had an atypical transformation zone in 15 patients (30%) and unsatisfactory colposcopy in one patient (2%). Histological examination of obtained biopsies revealed that: Five patients (10%) had viral changes with CIN I, two patients (4%) had CIN II, one patient (2%) had CIN III and eight patients (16%) had chronic cervicitis. Colposcopy had a positive predictive value of 50% i.e. 8 of 16 patients had a positive histopathology. Sensitivity of colposcopy was 88% and specificity was 79%. Cytology had a positive predictive value of 53% i.e. 8 of 15 patients had a positive histopathology. Sensitivity of cytology was 57% and its specificity was 84%. On comparison between colposcopy and cytology:Colposcopy (88%) was more sensitive than cytology (57%). Cytology (81%) was more specific than colposcopy (79%). Predictive values of positive results were comparable i.e. colposcopy was 50% and cytology was 53%. Mai Ahmed Gobran*, Safaa AbdelSalam Ibrahim, Sabah Mohamed Hanafy Department of Pathology, Zagazig University, Egypt *Address for Correspondence: Mai Ahmed Gobran, Department of Pathology, Zagazig University, Egypt; Tel: +201063477990; E-mail: magibran@medicine. zu.edu. eg Copyright: © 2021 Gobran MA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Received December 16, 2020; Accepted December 30, 2020; Published January 06, 2021