The Performance of Modified Swede Colposcopic Index to Predict High Grade Cervical Intraepithelial Neoplasia and Cervical Cancer in the Real Clinical Practice, an External Validation Study

Abstract

OBJECTIVE: The primary objective is to examine the external validity of the modified Swede colposcopic index (MSCI) for predicting cervical intraepithelial neoplasia grade 2-3, including cancer (CIN2+), and to evaluate inter-rater and intra-rater reliability as a secondary objective in women with abnormal cervical cancer screening. METHODS: We conducted a prospective study to predict CIN2+ in women aged 25-65 years with abnormal cervical cancer screening results (atypical squamous cells of undetermined significance (ASC-US) or higher and/or high-risk HPV infection). All participants were previously undiagnosed with CIN2+. We evaluated the effectiveness of MSCI in detecting CIN2+ using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: A total of 118 women were included in this study. Gynecologic oncologists using the MSCI achieved a sensitivity of 46.9%, specificity of 87.2%, PPV of 57.7%, NPV of 81.5%, and accuracy of 76.27%. Inter-rater reliability for the MSCI was good (ICC=0.77, 95%confidence interval=0.67-0.84), and intra-rater reliability was excellent (ICC=0.98, 95%confidence interval =0.97-0.99). CONCLUSION: In a real-world clinical setting, studies have demonstrated that MSCI exhibits high specificity while maintaining acceptable sensitivity.