Performance of Colposcopy for the Diagnosis of Histologic CIN2+ among Pap Smear Screen-PositiveWomen in a Camp Setting at Paro Hospital, Bhutan in 2021

Abstract

Objectives: Colposcopy camp is a way to reach colposcopy services in the community, reduce the burden on colposcopy centers, and reduce out-of-pocket expenses. This study assessed the sociodemographic profiles, colposcopy performance in diagnosing CIN2+ and cervical biopsy results among women who received colposcopy services during the colposcopy camp held at Paro Hospital, Bhutan, in 2021. Materials and Methods: This was a retrospective review of records of women with positive Pap smear screen who availed colposcopy services at Paro hospital, Bhutan, between August 30, 2021, and September 7, 2021. Data on sociodemographic characteristics, colposcopy, and histopathology diagnoses were retrieved from records maintained at the colposcopy clinic and the Department of Pathology and Laboratory Medicine, Jigme Dorji Wangchuck National Referral Hospital. Data entry and analysis were performed using SPSS version 25. Results: The mean age of study participants was 41 years (SD, 9 years). Among 84 women, 12 (14.3%), 31 (36.9%), and 41 (48.8%) had normal, low-grade lesion (LGL), and high-grade lesion (HGL) on colposcopy, respectively. Thirty-five (41.7%) underwent colposcopy-directed punch biopsy, and 33 (41.7%) underwent LEEP. The colposcopy sensitivity, specificity, and accuracy to diagnose histologic CIN2+ were 70.0 %, 56.82 % and 60.94 %, respectively. Whereas the sensitivity, specificity, and accuracy for the diagnosis of histologic CIN 2- were 30.77 %, 56.86%, and 51.56 %, respectively. The overtreatment rate with LEEP was 69.7%. Conclusion: The performance of colposcopy to diagnose histologic CIN 2+ was better than the diagnosis of CIN2-, and the over-treatment rate was high in this colposcopy camp setting.