RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
KARNATAKA
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / Name of the candidate and address /Dr. Waghmare sapna
D/o Mr.subhash waghmare
H.no.19/1/260.Ganga nivas.
Bankers colony.Shivnagar,South.Bidar.585401
2 / Name of the Institution / Kempegowda Institute of Medical Sciences & Research Center,
Bangalore 560 070.
3 / Course of the study and subject / M.S. in Obstetrics & Gynecology
4 / Date of admission to the course / 31st May 2012
5 / Title of the topic / STUDY OF COLPOSCOPIC EVALUATION OF THE UNHEALTHY CERVIX.
6 / Brief resume of the intended work
6.1 Introduction and need for the study
Carcinoma cervix is the most frequent of all the genital tract cancers accounting for 80% of all female cancers 1.Worldwide incidence is 5 lakh and 2,80000 people die due to carcinoma cervix annually.In India 1,26000 new cases are detected and 71,000 deaths occur annually 2.
Invasive cancer of cervix is considered to be a preventable condition, since it is associated with a long pre invasive stage making it amenable to screening and treatment. The most common indication for colposcopy is abnormal cervical cytology. The Papanicolaou’s (Pap) smear is the primary screening tool for Cervical Intra-epithelial Neoplasia (CIN).3
The simultaneous use of cytological studies and screening colposcopy has been shown to increase rate of cancer detection by 89 to 91 % .Colposcopy is found to be useful in understanding the morphology of the cervical lesions and in planning their management.A colposcopic guided biopsy is a must for evaluation of women with squamous intraepithelial lesions.
Hence, there is obvious need to subject women with clinically unhealthy cervix to colposcopy directed biopsy 4.
.
6.2 Review of literature
Shalini et al, studied the cytologic, colposcopic and histopathological
evaluation in patients with post coital bleeding and the sensitivity and specificity of
cytology was found to be 56% and 9O% respectively.5
Gullota, Margarati and Rabihi examined the correlation among Colposcopy, cytology and HPE in the diagnosis of intraepithelial lesions of cervix.Sensitivity for detection of CIN was 70% with cytology and 92% with Colposcopy
Olaniyan B., explained the validity of Colposcopy in the diagnosis of early
cervical cancer and concluded that Colposcopy is a valid tool for the diagnosis of
CIN. Its integral role in the management of early cervical cancer was Justified. 6
Etherington used video tele colposcopy to record colposcopic findings, which
were subsequently transmitted to a specialist for Interpretation. The sensitivity was
found to be 88.9% and’ specificity was 93 3%.8
Benedict J.L. did an analysis on 84244 patients from British Columbia by
Cytology and Colposcopy program and found that Colposcopy correlated with referral
Cytology within one degree in over 90% of cases and cytology histology correlation
Within one degree occurred in 82%.9
6.3 Objectives of the study
· To asses the role of colposcopy in the evaluation of unhealthy cervix
· To localize the lesions and to obtain biopsies from the selected areas
· To detect carcinoma of the cervix in its pre invasive stage.
7 / 7.0 MATERIALS AND METHODS
SAMPLE SIZE : 100
STUDY DURATION : January 2013 to June 2014
STUDY PLACE : Kempegowda Institute of Medical sciences.
STUDY DESIGN : Observational study
SAMPLE DESIGN : Purposive sampling
STATISTICAL ANALYSIS: The data collected will be analyzed using Chi square test.
7.1: SOURCE OE DATA
Women aged between 18-65 years with clinically unhealthy cervix attending gynaecology OPD at KIMS hospital, Bangalore.
7.2:METHOD OF COLLECTION OF DATA
INCLUSION CRITERIA :
1. Age: 18-65 years
2. Patients with abnormal symptoms like profuse white discharge, post
coital bleeding, intermenstrual bleeding and post menopausal bleeding.
3. Patients with pap smears showing dysplasia.
4. Patients with unhealthy cervix diagnosed by speculum
examination like, cervical erosion, cervical polyp,
condylomas , cervicovaginitis.
EXCLUSION CRITERIA :
1. Women with frank invasive cancer.
2. Patients with bleeding at the time of examination
PROCEDURE:
Detailed history of all patients according to proforma
After having met all the inclusion and exclusion criteria,written informed consent will be taken from all patients.
Pap smear will be taken.
Procedure: The patient is placed in dorsal position, the labia parted, and the Cusco’s self retaining speculum gently introduced without the use of lubricant or jelly. The cervix is exposed, the squamocolumnar junction is now scraped with Ayre’s spatula. The scrapings are evenly spread on a glass slide, and immediately fixed by dipping the slide in the jar containing equal parts of 95% ethyl alcohol and ether.
Patient will be subjected to colposcopy.
Procedure: The patient is placed in lithotomy position, the cervix is exposed with a bivalve speculum, cervix and vagina cleaned with normal saline in order to remove any discharge and the colposcope focused on the external os at a distance of about 20 cm.The squamocolumnar junction is brought into view and inspected before and after applying 3-5% aqueous acetic acid solution.Punch biopsy will be taken in all women under colposcopic guidance from acetowhite areas and sent for histopathology.
The findings will be broadly categorized into 5 groups – normal, unsatisfactory, abnormal colposcopy, invasive carcinoma (colposcopically suspected) and miscellaneous.
______
7.4 Has Ethical Clearance Been Obtained From your Institution In case of 7.3?
Yes
8 / References
1.Ramesh.G, Sudha R,Jayashree A.K,Padmini J.Colposcopic evaluation of unhealthy cervix.Journal of clinical and diagnostic research.2012.August.1026_1028.
2.MEDINDIA :Cancer incidence, mortality and prevalence worldwide.2012 October
3.Dasari P. A grossly abnormal cervix: Evidence for using colposcopy in the absence of a squamous intraepithelial lesion by the conventional Papanicolau’s test. Journal of Gynecologic Surgery. 2011 March; 27(1).
4. Singh SL, Dastur NA, Nanavat MS. A comparision of colposcopy and the Papanicolaou smear: sensitivity , specificity and predictive value. Bombay Hospital Journal. 2000 July; 42 (3).
5. Shalini. R, Amita. S, Neera. M.A, How alarming is post coital bleeding - a
cytologic, colposcopic and histological evaluation Gynaecol Obstet Invest.
1998, 45(3) : 205 – 8
6.Olaniyan O.B. Validity of Colposcopy in the diagnosis of early cervical
neoplasia a review - African Journal of Reproductive Health 2002, 6: 59 -
69.
7..Sukhpreet L Singh, Nayana A Dastur, Murari S. Nanavatti; Comparison of
colposcopy and pap smear : Sensitivity, specificity and predictive values
BHJ, No.4, Vol 42, Oct 2000.
8.Etherington. JJ, Telecolposcopy - A feasibility study in primary care, Dept.
of Obs. & Gyn, City Hospital, Birmingham, J. Telemed Telecare 2002; 8
supp 2 : 22 - 4.
9.Benedict. JL, Matistic. JP, Bertrand M.A, An analysis of 84244 patients
from the British Columbia Cytology - Colposcopy Program. J. Gynaecol
Oncol 2004 ; Jan 92 (1): 127 - 134.
9 / Signature of the candidate
10 / Remarks of the guide
To make screening for unhealthy cervix mandatory and to detect carcinoma cervix at
Its initial stage.
11 / Name and designation of
11.1 Guide / Dr.Nalini K.S
DGO , M.S O B G
Professor and Unit Chief
Department of OBG,
KIMS,Bangalore-560 070
11.2 Signature
11.3. Co-guide (if any) / -
11.4 Signature
11.5 Head of the Department / Prof. Dr. Nirmala Shivalingaiah
MBBS, M.S OBG
Professor and Head,
Department of OBG
KIMS, Bangalore 560 070
11.6 Signature
12 / 12.1 Remarks of Chairman and principal
12.2 Signature