Role of Colposcopy in the Evaluation of Visual Inspection of Cervix with Acetic Acid-positive Cases of Unhealthy Cervix
Authors: Begum Ferdousi , Kasem Setara B , Razzaque Shaikh A , Adiba Raisa , Anika Selma 
Published: September 2019

ABSTRACT
Introduction
Cervical cancer is the second most common cancer in women worldwide, and it is the principal cancer of women in most developing countries, where 80% of cases occur. This disease is preventable by screening and treatment of preinvasive condition. All sexually active women are at risk of acquiring a human papillomavirus (HPV) infection that may lead to cervical cancer in the future. Cervical cancer is a preventable disease as the different screening, diagnostic, and therapeutic procedures are effective. The screening procedures are visual inspection of cervix with acetic acid (VIA), Pap smear, colposcopy, and HPV deoxyribonucleic acid test. Among them, colposcopy is effective in screening, taking colposcopy-directed biopsy as well as treatment of cervical intraepithelial neoplasia (CIN), such as cold coagulation, cryotherapy, and loop electro-surgical excision procedure. Hence, there is an obvious need to subject the women with VIA-positive report to colposcopy and directed biopsy. This study is done to evaluate the role of colposcopy in evaluation of VIA-positive cases.

Objective
Colposcopic evaluation of VIA-positive cases and detection of precancerous lesion of cervix for early management.

Materials and methods
This was a cross-sectional study done among married female patient aged 22 to 65 years, who had VIA-positive report, and attending the colposcopy clinic in the Department of Obstetrics and Gynecology of Sir Salimullah Medical College and Mitford Hospital from January 2014 to December 2016. Colposcopy-directed punch biopsy was taken from the abnormal colposcopic appearance and specimen sent for histopathological examination.

Results
Out of 97 cases, all had VIA-positive acetowhite areas. But colposcopy revealed that 76.29% had CIN and invasive lesions, while 23.71% had either normal or inflammatory lesions. Colposcopy-directed punch biopsy revealed that 59.79% cases had positive lesions like CIN or invasive carcinoma and 40.21% had neither CIN nor invasive lesions. Among positive lesions, about 34.02% had CIN I, 3.09% had CIN II, 0% had CIN III, and 22.68% had invasive carcinoma. In this study, sensitivity and specificity of colposcopy examination were found 94.83 and 51.28% respectively.

Conclusion
Cervical cancer presents as major cause of morbidity and mortality, especially in developing countries like Bangladesh. In developing countries, the various screening programs are implemented for its early detection and treatment. It is evident that colposcopy plays a very important role in early diagnosis and treatment of preinvasive and early invasive carcinoma of cervix. So wide use of colposcopy in screening program of Bangladesh can reduce many young women's morbidity and mortality.

How to cite this article
Kasem SB, Razzaque SA, Adiba R, Anika S, Begum F. Role of Colposcopy in the Evaluation of Visual Inspection of Cervix with Acetic Acid-positive Cases of Unhealthy Cervix. J South Asian Feder Menopause Soc 2017;5(2):102-106.