Comparing the Effectiveness of Different Scoring System in “See and Treat Approach” for Cervical Precancerous Case Management
Priya Ganesh Kumar and Akshay Ganesh Kumar
Journal Title:Acta Scientific Cancer Biology
Indian healthcare is largely in the private domain which is not covered under any reimbursement program. Patients below the poverty line (BPL patients) show higher prevalence of sexually transmittable infections, of which HPV is one of the major contributor. “See and Treat” approach is largely favoured for treating the high grade cervical or lower genital abnormalities suspected to proceed to invasive disease in the foreseeable future. Colposcopy procedure is both diagnostic as well as curative for high grade cervical precancer and thus occupies an undisputed centre stage of cervical cancer prevention and control program in the clinical set up. A Reid Colposcopy Index (RCI) for grading the lesion severity determines colour change due to acetic acid, Margin Vascular pattern of the lesion along with change in colour with Lugol’s iodine and converts the subjective threshold for diagnosis and hence treatment intervention into a semiobjective one. The swede score has added the parameter of size of the lesion as well. The colposcopy grade scoring system therefore guides prediction of histologic diagnosis of the disease as well as determines which of these high grade lesions warrant immediate treatment by simple procedures like cryotherapy, thermocoagulation, leep therapy. “See and Treat” ap-proach is particularly also beneficial in the rural population settings where a trained clinical or pathological expertise may not be immediately available and skilled health workers may be trained to detect and eliminate the precursor disease. In our study, out of 650 cases who underwent colposcopy for varied reasons, 84 cases were detected to have lesions (12.9%). These lesions were scored according to RCI and Swede scoring systems. The lesions were biopsied for prospective histopathological findings. The clinical sensi-tivity, specificity, PPV, NPV, concordance and discordance between the two scoring systems were determined with histopathological diagnoses of high grade disease. In Reid’s scoring system, RCI score of ≥4 is taken as qualifying for HSIL detection and thus warrants treatment. In Swede scoring, a score of ≥ 5 is considered positive, warranting treatment. As per standard guidelines and protocol, CIN 1cases are usually kept under surveillance whereas CIN 2 and CIN 3 cases are taken up for treatment. In our practice, all case of CIN 1 were recalled for follow up, RCI scored well in terms of all the above parameters. RCI scored better as compared to Swede in terms of comparing overtreatment –RCI 24 % as compared to 42 % in swede. In our data of 84 samples the correlation between the scoring system of Swede and RCI was 0.65. However, the REID scoring had high concordance with histopathology compared to Swede sys-tem (R = 0.71 between REID and HP and R = 0.65 between Swede and HP). RCI is a better scoring system to avoid unnecessary over treatment as compared with Swede system in “See and treat” programs adopted in rural areas and camp set up. As per our study, our recommendation will be to safely use Swede score cut-off at ≥5, in the case of Reid score a cut-off of at ≥4 in “See and Treat” program.