Endocervicoscopy: a Novel Technique to Visualize the Transformation Zone in Cases of Incomplete Colposcopy

To evaluate the role of endocervicoscopy for visualization of transformation zone (TZ) in incomplete colposcopy.

This descriptive-analytical study was conducted between October 2019 and March 2021 (18 months) after obtaining ethics committee approval. A total of 92 women were recruited in the study after obtaining written informed consent. All screen-positive women and those having unhealthy looking cervix on colposcopy with TZ type 3 were included in this study. Endocervicoscopy was performed in all women by vaginoscopic approach, using a 4-mm continuous flow hysteroscope. The endocervical curettage was taken in all cases and sent for histopathological examination, and patients were managed as per this histopathology report. Sensitivity, specificity, PPV, and NPV of colposcopy and endocervicoscopy were calculated. p < 0.05 was considered statistically significant.

The mean age was 43.76 ± 13.02 years, and most women had parity ≥ 3 (48.9%). Endocervicoscopy has a success rate of 100% for completely visualizing TZ. There were 28 women where colposcopy was normal, but 5 out of these 28 women (17.8%) had findings on endocervix. Out of these 5 women, 3 were screened positive on Pap smear (1 LSIL, 1 SCC, 1 AGC) and 2 had unhealthy looking cervix. In total, there were two skip lesions in our study. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of colposcopy were 95.6%, 56.5%, 68.7%, 92.8%, and 76.1% and of endocervicoscopy were 100%, 80.5%, 58.8%, 100%, 84.8%, respectively.

Endocervicoscopy is a reliable and feasible method to detect the transformation zone in patients with TZ type 3 with a success rate of 100% and a short learning curve. Skip lesions can be detected, and the precise localization of the lesions allows for the depth of cone excision to be tailored, thus leading to a more conservative treatment.