title: Histological diagnosis and evaluation of the Swede score colposcopic system in a large cohort of pregnant women with atypical cervical cytology or cervical malignancy signs.
abstract: OBJECTIVE
  We evaluated the distribution of histological diagnoses in pregnant women with atypical cytology or cervical malignancy signs, as well as the usefulness of the Swede score colposcopic scoring system to reduce the need for diagnostic cervical biopsy.
  
  
  METHODS
  Prospective clinical study.
  
  
  METHODS
  The study comprised 261 pregnant women undergoing colposcopic investigation because of atypical cervical cytology, dysplastic biopsy changes, recurrent non-obstetric bleeding or pathological appearance of the cervix.
  
  
  METHODS
  Five colposcopic variables (acetowhiteness, margins plus surface, vessel patterns, lesion size and iodine staining) were scored with 0, 1 or 2 points. Colposcopically directed biopsies or loop electrosurgical excision biopsies were taken from all lesions. Histology was compared with the colposcopic score. Sensitivity and specificity were calculated for each variable, and the combination of all five variables, with high-grade lesions (i.e. cervical intraepithelial neoplasia (CIN2, CIN3 or adenocarcinoma-in-situ (AIS)) as endpoints.
  
  
  METHODS
  Colposcopic score (Swede score) and histology (CIN1, 2, 3; AIS; cancer).
  
  
  RESULTS
  The specimens consisted of normal tissue in 19.5% of cases, low-grade lesions (i.e. CIN1, koilocytosis, glandular dysplasia of lower grade than AIS) in 26.1%, high grade lesions in 52.9% and cancer in 1.5%. All high grade lesions and cancers had total Swede scores of ≥ 5 and ≥ 8, respectively. Vessel patterns, lesion size and margins plus surface were most important for high grade lesion detection.
  
  
  CONCLUSIONS
  The Swede score seems to be a useful tool in evaluating atypical cervical cytology in pregnant women and may reduce the need for diagnostic biopsies.
authors.affiliation: Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. cecilia.karrberg@vgregion.se
authors.forename: Cecilia
authors.initials: C
authors.lastname: Kärrberg
authors.forename: Walter
authors.initials: W
authors.lastname: Ryd
authors.forename: Björn
authors.initials: B
authors.lastname: Strander
authors.forename: Mats
authors.initials: M
authors.lastname: Brännström
authors.forename: Thomas
authors.initials: T
authors.lastname: Rådberg
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D019540:Area Under Curve; D001706:Biopsy / Q000009:adverse effects; D015331:Cohort Studies; D003127:Colposcopy; D003584:Cytological Techniques; D005260:Female; D005865:Gestational Age; D006801:Humans; D016015:Logistic Models; D060787:Neoplasm Grading; D011237:Predictive Value of Tests; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013548:Sweden; D019564:Unnecessary Procedures; D002578:Uterine Cervical Dysplasia / Q000150:complications / Q000473:pathology*; D002583:Uterine Cervical Neoplasms / Q000150:complications / Q000473:pathology*; D014592:Uterine Hemorrhage / Q000209:etiology