Correlation of Reid's Colposcopic Index (RCI) with Histopathology in Identifying Cervical Intraepithelial Neoplasia (CIN): A Prospective study

BACKGROUND: Cervical cancer being a global health problem, is the leading cause of death in women in developing countries. WHO projections in 2005 says that over 5,00,000 new cases of cervical cancer are being identified, of which over 90% were from developing countries. Screening procedures include Pap smear, HPV DNA testing, visual inspection with acetic acid and visual inspection with lugol’s iodine. However, colposcopy remains the gold standard for assessing the validity of all the screening procedures. Reid Colposcopic Index (RCI), an objective index to make colposcopic diagnosis less subjective. This study was mainly undertaken to identify and evaluate the diagnostic efficacy of colposcopy using RCI and to determine the degree of correlation between colposcopic impression and histopathology. AIMS AND OBJECTIVES: 1. To estimate the diagnostic efficacy of colposcopy. 2. To determine the strength of correlation between Reid's colposcopic index and histopathological report in determining cervical intraepithelial neoplasia. MATERIALS AND METHODS: All women with VIA and VILLI positive from general OPD are sent to Colposcopy room .After obtaining informed consent for the study from the patients in the colposcopy room, colposcopy and biopsy are performed. Adequate colposcopy was defined when all four quadrants of cervix visible. The margins of the atypical cervical epithelium were graded according to a number of features, including sharpness, conformation, and thickness of the border and the presence of internal margins in a lesion. And Finally, the lesion was assessed after iodine staining. Scoring of all the findings based on Reid's score is made. Correlated with histopathological report prospectively obtained. RESULTS: Association between RCI and histopathology had a significant association between both (p value <0.001, using Fischer’s exact test). We tried to evaluate the level of agreement between both the test using Kappa statistic, and we found that the level of agreement was found to be K=0.72 (95%CI 0.63-0.80), i.e, there was 72% agreement between both the tests in diagnosis of cervical cancer. And this was found to be statistically significant (p value 0.045). Colposcopic RCI index did an overestimation in around 23 (15%) individuals, and it underestimated the results in 17 (11%) of the study participants. We did spearmen correlation analysis to interpret the correlation between Colposcopic RCI index interpretation and Biopsy findings. We found that found were highly correlated with an r value of 0.85 (p value < 0.001). CONCLUSION: Colposcopy is an indispensable tool in the diagnosis of precancerous lesions that is cervical intraepithelial neoplasia. There is a good correlation between colposcopic impression using RCI & histopathology which makes it a good reproducible technique which is easy to implement in colposcopy clinics. LIMITATIONS OF THE STUDY: 1. Colposcopy and its details need expertise, which is of utmost importance for delineating the lesions and identifying them correctly. 2. Not everybody in the peripheral centers are very well trained in colposcopy which makes this study difficult to be applied in centers lacking people trained in colposcopy. 3. Not all centers have colposcope and expertise in colposcopy. 4. Reid's index gives score by 4 attributes and the scores usually gives reports which are overlapping, which makes RCI to provide Cut off for each value to identify it as CIN I or II or III