Reliability of Colposcopic Descriptive Appearances in Oral Pre-Cancers-A Clinico-Patho-Colposcopic Study

Context: The single most important factor that is known to improve the end result of head and neck cancer is the early diagnosis of these cancers while they are still localized and can be treated with a high probability of cure. Early diagnosis of cancer plays a life saving pivotal role in overall management. The technique of colposcopy enables evaluation of changes in surface topography and vascular patterns of the lining mucosa thus, aiding in selecting the most appropriate site of biopsy ruling-out the possibility of taking biopsy from the most representative area supposed to reveal epithelial dysplasia. In view of intraoral application of micro-colposcopy, it was felt that colposcopy might provide a useful aid for the early enough diagnosis of oral pre-cancerous and cancerous lesions and conditions affecting the oral mucosa to improve the prognosis. Aim: To clinico-pathologically correlate cases of oral pre-cancers; correlate the surface characteristics revealed by micro-colposcopy with the histopathological diagnoses of the sites under observation; and map out the areas of surface dysplasia to indicate the full extent of epithelial changes before taking the biopsy specimen to take specimen from areas most representatives of dysplasic features (guided biopsies). Settings and Design: Methods and Material: A total 27 subjects were studied including 10 cases each of oral submucous fibrosis and hyperkeratotic lesions including homogeneous and non-homogeneous leukoplakias, 6 cases of oral lichen planus and a case of clinically suspected oral squamous cell carcinoma. Results: In the present study, a sensitivity of colposcopic screening test came-out to be about 71% while specificity was about 92%. Positive predictive value was 91%. Conclusion: Although the degree of abnormality in colposcopic findings can be predicted by the vascular patterns of the lesion, the major advantage of colposcopy is to outline the most suspicious lesion for histologic diagnosis by directed biopsy which is the mainstay in establishing the correct diagnosis. Colposcopy is valuable in the detection of early cancerous lesions; however the final diagnosis must rely on a meticulous histopathological examination by an expert pathologist.