Colposcopic evaluation of unhealthy cervix before and after premedication with vaginal misoprostol in comparison with different assessment methods

Abstract EN

Objective: The aim of this prospective study is to assess the usefulness of cytopathologic and colposcopic examination in investigating patients with unhealthy cervix and comparison between the accuracy of these tools.

With the use of Misoprostol in case of unsatisfactory colposcopy.

Design: Prospective randomized clinical study.

Setting: The study was implemented at outpatient Clinic of Obstetrics and Gynecology Department at Al-Azhar University Hospitals from April 2013 till April 2015 .

Patients and Methods: A total of 150 patients were enrolled in this study.

Cytology, colposcopy, and colposcopic guided punch biopsy were taken from all.

In case of unsatisfactory colposcopy ,vaginal Misoprostol was used .Cases that remains unsatisfactory after Misoprostol; endocervical curettage was performed.

Main outcomes: Colposcopy was proved to be more sensitive than cytology (83% versus 31%) and specificity of both were almost comparable ( 96% versus 89%).

Results: Cytology identified 5 patients with (LG-SIL), one patient with (HG-SIL),134 patients with non-specific inflammation, cancer cervix not seen in any patient and 10 patients had atypical squamous cells.

Colposcpy revealed abnormal colposcopic findings in about 6 patients, majority of the patients (129) has normal colposcopic findings , and 15 patients has unsatisfactory colposcopy ,three of them turned to be satisfactory after Misoprostol.

Histopathological examination of the biopsies revealed that no invasive cancer was detected ,4 patients has (LG-SIL), and one patient had (HG-SIL).

Conclusion and recommendation: In women with unhealthy cervix that the index of suspicion of malignancy is high, investigation work up through smear and colposcopy is mandatory in all cases.

Cytological changes is difficult to predict by simply looking at the cervix .

It is necessary for all sexually active women to undergo cytological evaluation whether the cervix looks healthy or not .Lastly, since the majority of cases showed inflammatory changes, effort must be made to look for specific infection and appropriate therapy instituted.