Geburtshilfe Frauenheilkd 2014; 74 - PO_Onko04_13
DOI: 10.1055/s-0034-1388396

RIO 2011: Mandatory colposcopic findings in diagnosis of severe cervical dysplasia

NK Schmidt 1, CR Barop 1, I Indorf 1, DA Beyer 1
  • 1University Hospital Schleswig-Holstein, Campus Lübeck, Obstetrics and Gynecology, Lübeck, Germany

Objective: Current colposcopic nomenclature differs in minor, major and non-specific signs in the group of abnormal colposcopic findings. Study aim: Analysis of different aspects of major changes, comparing them to histologically confirmed severe dysplasia and thus to determine mandatory colposcopic findings of severe cervical dysplasia.

Materials and methods: Retrospective cohort analysis of n = 325 histologically confirmed colposcopic examinations by the dysplasia unit at the Department of Obstetrics and Gynecology of the University Hospital Schleswig-Holstein, Campus Lübeck between 09/2009 and 10/2013. Examinations were performed with a Leisegang 3MVS LED colposcope (45,000 – 52,000 Lux; 300 mm free working distance) with integrated camera. Portio-examinations: natively, aceto and iodine stained. Results were analyzed, dividing the examinations into 2 groups according to their biopsy results: group 1: CIN2 + CIN3; group 2: other. Main outcome parameter were defined: coarse leukoplakia, mosaic and punctuation, dense acetowhitening, sharp boarders, ridge sign, atypical vessels, pap smear IVa/V.

Results: Group 1: n = 136, group 2: n = 189. Coarse leukoplakia, sharp boarders, ridge sign and atypical vessels showed no significant differences between both groups. Coarse punctuation (19.1% vs. 3.2%; p < 0.001) and coarse mosaic (26.5% vs. 9%; p < 0.001) occurred significantly more frequently in CIN2 or CIN3 cases as well as dense acetowhitening (47.1% vs. 30.7%; p < 0.005). Moreover, group 1 showed significantly higher rates of cytological pap smears IVa/V (48.5% vs. 11.5%; p < 0.001).

Conclusion: Coarse punctuation and mosaic as part of the major changes in the RIO classification have got the highest positive predictive value for a CIN2 or CIN3 lesion, closely followed by the acetowhitening.