title: The Swede score: evaluation of a scoring system designed to improve the predictive value of colposcopy.
abstract: OBJECTIVE
  It has been suggested that the accuracy of colposcopy is less reliable than once presumed. The Reid colposcopic index is the most well-known scoring system designed to standardize colposcopic assessment and assist in the prediction of histological diagnosis. Strander et al. have devised a new scoring system, the Swede score, which includes lesion size as a variable. This evaluation aimed to validate the Swede score within a London teaching hospital colposcopy unit.
  
  
  METHODS
  An evaluation was carried out of women undergoing colposcopy at the Royal Free Hospital, London, UK. For 4 months, 200 women attending diagnostic colposcopy clinics or undergoing inpatient treatment of cervical intraepithelial neoplasia (CIN) were included. Participating colposcopists comprised both trained and trainee colposcopists. Swede scores were calculated at the time of colposcopy and recorded; they were compared with the final histological diagnosis after either directed or excisional cervical biopsy. Because this was an evaluation and not a research study, the Swede score was not used to influence the patient management in anyway.
  
  
  RESULTS
  Swede scores of 8 or more had a sensitivity, specificity, and positive and negative predictive values of 38%, 95%, 83%, and 70%, respectively, for lesions where the final diagnosis was CIN 2 or higher. Using the same cutoff score of 8 or higher, the first 100 examinations had similar results compared with the second set, showing that no major learning curve existed when using the Swede score.
  
  
  CONCLUSIONS
  Because the specificity when scoring 8 or higher was 95%, it is possible that higher scores within this system might be used to more accurately predict CIN 2 or higher. There was no obvious learning curve, and trainees showed comparable results compared with their trained colleagues.
authors.affiliation: Academic Department of Obstetrics and Gynaecology, Colposcopy Unit, Royal Free Hospital, London, UK. Julie.bowring@royalfree.nhs.uk
authors.forename: Julie
authors.initials: J
authors.lastname: Bowring
authors.forename: Bjorn
authors.initials: B
authors.lastname: Strander
authors.forename: Martin
authors.initials: M
authors.lastname: Young
authors.forename: Heather
authors.initials: H
authors.lastname: Evans
authors.forename: Patrick
authors.initials: P
authors.lastname: Walker
mesh_terms: D003127:Colposcopy / Q000379:methods* / Q000592:standards*; D005260:Female; D006651:Histocytochemistry; D006784:Hospitals, Teaching; D006801:Humans; D008131:London; D012720:Severity of Illness Index; D002577:Uterine Cervical Diseases / Q000175:diagnosis* / Q000601:surgery*; D014623:Vaginal Diseases / Q000175:diagnosis* / Q000601:surgery*