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Video monitoring of smear‐taking at colposcopy: relationship to cytology
Author(s) -
AlAwadhi Rana M.,
Mansell Elizabeth,
Chong Swee,
Chow Carl,
Singer Albert,
Coleman Dulcie V.
Publication year - 2004
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2004.00231.x
Subject(s) - colposcopy , medicine , cytology , gynecology , biopsy , cervix , sampling (signal processing) , obstetrics , cervical cancer , radiology , cancer , pathology , filter (signal processing) , computer science , computer vision
Objective To investigate the reasons why cervical smears occasionally fail to reflect the underlying pathology in the cervix even when the smear is taken at colposcopy. Design A randomised study of three different smear‐taking devices. Setting A colposcopy clinic. Population Women attending the colposcopy clinic. Methods A smear was taken from 172 nulliparous and 100 multiparous women at colposcopy and the procedure was monitored on a video‐imaging system. The cytological findings were compared with the biopsy report in 147 nulliparous and 85 multiparous women. Main outcome measures Accuracy of cytology and the effect of a range of variables on the accuracy of cytology. Results Sampling of the transformation zone was incomplete in 15% of nulliparous women and 8% of multiparous women. Univariate analysis of a range of variables including parity, type of sampling devices, completeness of sampling of the transformation zone, size of the transformation zone, size of the lesion (aceto‐white area) and location of the squamo‐columnar junction showed that the accuracy of cytology was influenced by all these factors except for parity and smear‐taking devices. Multivariate analysis showed that the location of the squamo‐columnar junction, the size of the transformation zone area, the size of the aceto‐white area and the ratio of the aceto‐white area to the area of the transformation zone influenced the accuracy of cytology. Conclusions Women with large transformation zone areas (>30.03 mm 2 ) and/or small aceto‐white lesions (<7.01 mm 2 ) are more likely to have an inaccurate cytology reports than women with small transformation zone and women with larger aceto‐white areas. A ratio of the aceto‐white area to the area of the transformation zone of 0.22 or less increases the risk of disagreement between the cytological and histological findings.